Associate, Prior Authorization

In this role, you will manage the day-to-day submission and follow-up of claims and Prior Authorizations submitted to patients’ insurance. You will be both patient and provider-facing, from shepherding patients through the benefits process, to coordinating with providers to ensure all claim information is accurate. As a Prior Authorization Associate you’ll provide efficient and effective support to the Customer Experience team, our providers, and patients across our brands. You must be comfortable speaking with others across various channels (email and phone) compassionately and professionally. Above all, you embody the Thirty Madison mission of providing access to healthcare for all who suffer from chronic conditions.

Comp | Perks | Benefits 

• The base pay range for this position is $18.50 per hour.**
• Annual Incentive Plan + Stock Option Package
• Robust and affordable Health, Dental, and Vision plan options 
• 401k with a match, commuter benefits, and FSA
• Annual $750 vacation stipend and $500 happiness stipend
• Vacation time off policy - up to 10 vacation days accrued your first year. Vacation time begins accruing immediately.

**Base pay offered may vary depending on job-related knowledge, skills, and experience. An annual incentive plan and stock options may be provided as part of the compensation package, in addition to a full range of medical, financial, and/or other benefits, dependent on the position offered.

What you get to do every day

• Coordinate with providers to attain medical necessity documentation to expedite PA and claims approvals and perform the appropriate follow-up
• Process all paperwork/forms related to medication prior authorizations, including electronic distribution (fax, web-site applications, and/or telephone)
• Validate patient’s insurance plans, prescriptions, and eligibility
• Review and submit claims to insurance payers. Verify accuracy and completeness of all required information prior to submission.
• Identify and review, code and abstract clinical information and assign correct ICD-10 & CPT codes 
• Develop expertise on insurance processes, benefits, and exclusions to support patients in navigating billing inquiries or concerns
• Investigate insurance claim denials, exceptions, or exclusions. Take necessary action to resolve claim and payer issues in an effort to recover proper reimbursement.
• Other ad-hoc, medical-operations related tasks

What you bring to the role

• Knowledge of prior authorization
• Basic understanding of human anatomy, specifically musculoskeletal
• Proficient use ICD-10 codes
• Excellent communication skills, knowledge of general clerical duties, and cultural competency for communicating with people of various backgrounds
• Excellent customer service skills; communicates clearly and effectively with great attention to detail
• Ability to multitask, stay organized, and remain focused while managing a high-volume, time-sensitive workload
• Excellent computer skills including Excel, Word, and internet use
• Able to adapt to changing situations with minimal assistance
• Regular and reliable attendance, adherence to a scheduled shift; ability to work a rotating shift, as well as one weekend day a month

Physical Requirements

• Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7 to 8 hours per day.
• Vision sufficient for use of a computer monitor

Required IT

• Reliable at home internet with a download speed of at least 25 Mbps and an upload speed of at least 5 Mbps

 

About Thirty Madison 

Thirty Madison is a family of specialized healthcare brands devoted to creating exceptional outcomes for all. Each of its specialized brands is focused on a specific ongoing condition, and thoughtfully designed to support the unique needs of its community with personalized treatments and care; with Keeps for men's hair loss, Cove for migraine, Picnic for allergies, Facet for skin conditions, and NURX for sexual health. With empathy at the heart of its innova