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Insurance, Prior Authorization Specialist
TEKsystems. Serve as a subject matter expert in insurance billing, claims processing, and prior authorizations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance billing, claims processing, and prior authorizations, with a strong ability to communicate effectively with healthcare providers and patients. Proficient in utilizing internal systems for documentation and verification of medical and prescription insurance coverage.
Highest-signal resume keywords
Insurance Billing ExpertiseClaims Processing KnowledgePrior Authorization ManagementHealthcare Call Center ExperiencePharmacy Operations 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
Claims ProcessingInsurance VerificationPrior AuthorizationAppeal FilingBilling KnowledgeReimbursement ProcessesPharmacy OperationsDocumentation SkillsPatient Information EntryFinancial Assistance Knowledge
Soft Skills
Effective CommunicationCollaborationAttention to DetailProblem-SolvingInterpersonal Skills
Tools & Technologies
Hub Information SystemCore Pharmacy SystemWeb Tools for Benefits Investigation
Industry Keywords
HealthcarePharmacyInsurance ProgramsCommercial InsuranceGovernment InsuranceReimbursement SettingHealthcare Provider LiaisonPatient DemographicsCall Center EnvironmentSpecialty Pharmacy
About the role
Key responsibilities & impact- Serve as a subject matter expert in insurance billing, claims processing, and prior authorizations
- Liaise between departments, payors, and providers to determine patients’ overall prescription coverage
- Provide expertise on medical and prescription insurance coverage verification, claim billing, medication prior authorization, appeal filing, and alternate financial assistance opportunities
- Accurately document information in appropriate systems and formats
- Communicate referral status to physicians and patients via phone, fax, and/or the core pharmacy system
- Assist offices through the documentation and filing process for prior authorizations and appeals
- Monitor authorization and appeal status to support rapid turnaround and procurement of drug products
- Use internal and web tools to investigate pharmacy and medical benefits
- Collaborate with health insurance payors and providers and maintain payor intelligence resources
- Enter patient demographic and health insurance information into the hub information system
- Notify physicians of incomplete or incorrect insurance information
Requirements
What you’ll need- 1–3 years of work experience in a healthcare or reimbursement setting
- Previous experience in a call center environment, healthcare office, corporate setting, healthcare insurance provider, or pharmacy is required
- Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs
- Knowledge of billing, alternate funding resources, reimbursement processes, insurance verification, prior authorization and appeal filings, and specialty pharmacy operations
- Pharmacy call center experience is an advantage
- Healthcare call center and medical claims experience is an advantage
Benefits
Comp & perks- Medical, dental & vision
- Critical Illness, Accident, and Hospital coverage
- 401(k) Retirement Plan with pre-tax and Roth post-tax contributions
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short- and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)