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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in prior authorization processes, appeals management, and healthcare billing, with a strong understanding of insurance policies and medical terminology. Proficient in communication and collaboration with healthcare providers and insurance companies to ensure efficient authorization outcomes.
Highest-signal resume keywords
Prior Authorization ManagementHealthcare Billing ExperienceInsurance Policies KnowledgeSalesforce ProficiencyHIPAA Compliance Understanding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior AuthorizationAppeals ManagementMedical TerminologyInsurance VerificationCoding Knowledge
Soft Skills
Strong Communication SkillsInterpersonal SkillsAttention to DetailOrganizational Abilities
Tools & Technologies
SalesforceXifinGoogle AppsMac OS XCRM Applications
Industry Keywords
Healthcare BillingInsurance GuidelinesPayer RequirementsPeer-to-Peer ReviewAuthorization Delays
About the role
Key responsibilities & impact- Review and resolve prior authorization inquiries in Salesforce
- Research accounts requiring appeals for prior authorization denials
- Prepare and submit appeals to insurance companies with required medical records, documentation, and justification
- Review and resolve rejected authorizations
- Communicate with healthcare providers and insurance companies to facilitate peer-to-peer review
- Submit and track prior authorization requests using appropriate systems and tools
- Ensure documentation is complete and accurate to avoid authorization delays
- Track appeal outcomes and follow up on unresolved cases
- Collaborate with clinical teams, billing, market access, and insurance representatives
- Provide management with regular updates on authorizations and appeals
- Stay informed about insurance guidelines and payer requirements
- Communicate with internal and external stakeholders
- Perform additional duties as assigned
Requirements
What you’ll need- 3-5 years of experience in healthcare billing, with a focus on prior authorizations and appeals
- Strong understanding of insurance policies, medical terminology, and coding
- Knowledge of insurance authorization and verification processes for major health plans
- Strong communication and interpersonal skills
- Experience using Google Apps, Mac OS X, and CRM applications
- Understanding of HIPAA regulations for healthcare
- Xifin, SalesForce, and careviso experience is a plus
- Ability to support EST hours
- Exceptional attention to detail and organizational abilities
- No certificates, licenses, or registrations required
- High school diploma preferred
Benefits
Comp & perks- Competitive compensation and benefits reflecting local market practices and legal requirements
- Fully remote work from a home office or other suitable remote location
- Flexible schedule and hours established in collaboration with the leader and adjusted to business needs
- Reasonable accommodations for individuals with disabilities