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DeCoach Recovery

Prior Authorization Specialist (Remote after training)

Career Insights for Medical Claims Processor / Representative

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$40,814 / year median in Ohio

-9% projected decline

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Job Description

DeCoach Recovery is a leading addiction treatment center dedicated to providing compassionate care and effective solutions for individuals battling addiction. We take the time with every client to understand their needs and where they are on their recovery journey to help them not only reach sobriety, but to stay sober long-term. We are currently hiring for a prior authorization specialist to work at our Sharonville Headquarters. You will be responsible for obtaining necessary approvals from insurance providers prior to patients starting treatment or medications. You will review clinical documentation, submit authorization requests, and communicate with healthcare providers and payers to ensure coverage requirements are met. The role includes tracking requests, resolving issues and denials. This position can become remote once training is completed.
Minimum Qualifications:
High school diploma or equivalent; associate or bachelors degree preferred.

Minimum of 2 years experience in prior authorizations or in a revenue cycle roleExcellent communication and negotiation skills.

Proficiency with technology including
Microsoft Office SuiteResponsibilities:
Verify patient eligibility and coverage limitsReview medical charts to ensure clinical notes match what insurance requiresSend requests for prior approval to insurance providersTrack pending cases and follow up with insurance agents
Benefits:
Medical, Dental and Vision BenefitsYearly Merit RaisesA Company Matched 401(k) planTuition ReimbursementSTAR Eligible Facilities to Assist with Student Loan ForgivenessPTO and Paid HolidaysOpportunities for Advancement