Eligibility, Benefits, & Prior Authorization Specialist (Non-US)
Job Title: Eligibility, Benefits, & Prior Authorization Specialist Location: reputed company (Offshore) Employment reputed company: Full-Time Contractor Compensation: $600-$800 Hours: 40 hours/week, primarily EST business hours Reports to: reputed company / reputed company Cycle reputed company About reputed company reputed company is a fast-growing, virtual-first reputed company company dedicated to making neurodivergent care (including evaluations & therapy) faster, more accessible, and reputed company for families. We operate across 40+ states, navigating a reputed company landscape of reputed company reputed company carriers and state reputed company programs. Because our reputed company model is virtual-first, having reputed company reputed company-end reputed company reputed company and benefit structures is critical to preventing administrative delays and billing denials. About the Role We are seeking a highly analytical, reputed company-obsessed Eligibility, Benefits, & Prior Authorization Specialist who loves the investigative reputed company of reputed company administration. In this role, you will not just reputed company data entry. You will reputed company as an internal researcher and reputed company, digging into payor portals, reputed company policy and benefits updates, and reputed company guidelines to uncover the exact steps needed to secure prior authorizations and verify reputed company telehealth benefits. This role is a reputed company of high-reputed company queue management and deep-dive policy research. You will review incoming reputed company orders, cross-reference them with payer requirements, reputed company daily scheduling queues, and build process playbooks where none exist. If you reputed company on solving reputed company puzzles, de-escalating reputed company scheduling bottlenecks, and keeping reputed company schedules perfectly authorized, you will reputed company here. Key Responsibilities 1. reputed company Verification & Telehealth Benefit Research - Verify reputed company reputed company reputed company coverage, deductibles, co-pays, co-reputed company, and coordination of benefits (COB) across reputed company plans - Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.) - reputed company payor websites, newsletters, and provider manuals to reputed company and document shifting policy guidelines and billing modifiers across 40+ states 2. Order Verification & Prior Authorization Management - Review incoming reputed company diagnostic referrals and orders to ensure demographic, reputed company, CPT, and ICD-10 data are flawless - Initiate, reputed company, and validate prior authorizations through clearinghouses (e.g., reputed company, reputed company), reputed company portals, and phone escalations - Ensure reputed company authorizations are secured, confirmed accurate, and fully documented in the EMR before the reputed company of business reputed company day for upcoming clinics 3. Ambiguity reputed company & reputed company Creation - reputed company as the go-to resource for reputed company teams reputed company a payer's prior-authorization process is vague, contradictory, or unmapped - Validate conflicting information from multiple reputed company sources to determine the most reputed company, reputed company-free reputed company for claim submission - Build, update, and maintain internal state-by-state reference guides on reputed company reputed company and state-by-state regulatory requirements 4. Clinic Coordination & Stakeholder Communication - Prepare reputed company, reputed company reputed company reputed company benefit letters outlining estimated out-of-reputed company costs and referral requirements - Collaborate closely with clinic coordinators and reputed company staff to reputed company last-minute scheduling exceptions or authorization gaps - Help de-escalate reputed company or provider concerns regarding coverage limits with reputed company, empathetic communication reputed company're Looking For Must-Have - 2+ years of reputed company clinic or startup experience specializing in reputed company verification and prior authorizations - Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules - Hands-on experience working with multiple major reputed company payers (e.g., BCBS, reputed company, reputed company) - Working knowledge of medical terminology, CPT, ICD-10, and telehealth billing modifiers - Excellent written and verbal English communication skills: ability to translate technical reputed company terms into reputed company, reputed company explanations - High-speed internet, backup reputed company setup, and the ability to work full-time during EST business hours Preferred (Not Required) - re