Reimbursement Specialist - Prior Authorization

About the Role:As a Reimbursement and Prior Authorization Specialist, you are vital to our success. You will collaborate across teams to secure insurance preauthorizations, streamline billing operations, and ensure accurate and complete documentation, supporting our mission to advance cancer care.Essential Duties and Responsibilities:● Act as a primary contact for insurance companies to obtain necessary preauthorizations for patient services.● Collaborate with billing systems, finance, and client services teams to facilitate timely payment processing.● Maintain and update a comprehensive database of payer authorization requirements.● Manage all documentation related to payer communication, correspondence, and insurance claims research.● Track, report, and resolve complex claims, ensuring prompt follow-up and resolution.● Troubleshoot Explanation of Benefits (EOBs), identify claim issues, and escalate as needed.● Appeal non-covered or incorrectly adjudicated claims through external review processes.● Drive positive coverage decisions via appeals and external review organizations.● Ensure compliance with Medicare, Medicaid, and other third-party payer requirements and online eligibility/preauthorization systems.● Support continuous improvement of billing and authorization processes aligning with company values.