Prior Authorizations Coordinator

Job DescriptionJob Description

Job Title: Prior Authorizations Coordinator

Company: Food Allergy Institute

Location: Long Beach, CA

Hours: Full Time; M-F 8:00AM-5:00PM (Onsite)

Pay: $23- $25 per hour

Who We Are:

Founded in 2015, Food Allergy Institute (FAI) is a cutting-edge research and clinical care center revolutionizing food allergy treatment among the pediatric population. Our Tolerance Induction Program™ is the first of its kind, bringing patients to the point where they can eat whatever they want, whenever they want, without having to worry about any kind of reaction. The success of FAI is built on years of development involving proprietary biomarkers, data analytics and modeling systems which allow unique patient specific therapy to be deployed in the clinic setting and at home safely.

Why FAI?

Food Allergy Institute is home to many innovative thinkers, problem solvers, and passionate leaders. The work we do is truly life-changing for our patients and their families; each member of our team will experience how their role supports our mission! FAI provides a challenging and rewarding environment where employees’ talents are leveraged, ideas are encouraged and growth is always inspired.

FAI currently employs over 170 employees! Our diverse team includes roles such as: Physicians in the specialties of Pediatrics, Pulmonary, Allergy, Emergency Medicine, and Immunology, as well as Nurse Practitioners and Physicians Assistants, and a PhD level research team. In the food allergy world, the growth of FAI is unique in reflecting the effectiveness of its treatment approach and the supportive environment fostered by its team of professionals.

Benefits:

• Health Insurance
• Vision Insurance
• Dental Insurance
• PTO Days
• Paid Holidays
• 401K Plan (matched)
• Professional Development
• Paid Training
• Company Sponsored Events
• Competitive Rates
• Growth Opportunities

Job Purpose:

The Prior Authorization Specialist is responsible for reviewing and processing prior authorization requests for medical services and prescriptions. This role ensures that patients receive necessary treatments in accordance with their insurance coverage, while also managing communication with healthcare providers, insurance companies, and patients to verify benefits and eligibility.

Duties and Responsibilities:

• Review and submit prior authorization requests for medical services, procedures, and medications to insurance companies or third-party payers.

• Verify patient insurance coverage, eligibility, and plan limitations to determine the necessity of prior authorization.

• Communicate with healthcare providers (physicians, providers, nurses, etc.) to gather required documentation, such as medical histories and prescriptions.

• Submit claims and follow up with insurance companies for approvals, denials, or further information requests.

• Address any denied claims by working with healthcare providers to submit appeals or adjust the requested services or medications.

• Inform patients about the status of their prior authorization requests, insurance coverage, and potential out-of-pocket costs.

• Maintain accurate and detailed records of all authorization requests, approvals, denials, and communications in the medical management system.

• Work closely with clinical staff, billing departments, and other administrative teams to ensure a smooth and timely prior authorization process.

• Look for areas of opportunity and communicate these to leadership.

• Ensure compliance with federal, state, and payer regulations regarding prior authorizations and insurance claims.

• Complete all other duties as assigned.

Qualifications:

• High school diploma or equivalent required; completion of medical billing and coding or Medical Assistant program preferred.

• At least 2-3 years of experience as a Medical Assistant or with prior authorizations.

• Knowledge of medical terminology and insurance processes.

• Experience with medical billing systems and electronic health records (EHR).

• Highly organized with strong attention to detail and follow-up.

• Team Mentality and a positive working attitude.

• Strong verbal and written communication skills.

• Excellent interpersonal and customer service skills.

• Excellent time management skills and self-starter mentality.

• Ability to work in a fast-paced environment that requires strong multi-tasking skills

Physical requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).

This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

Direct reports:
N/A

The company provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws. The company is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act.

Location: Signal Hill, CA, US

Posted Date: 11/1/2024