Authorization and Verification Research Specialist
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Authorization and Verification Research Specialist investigating payor requirements for healthcare providers. Supporting patients' access to care by helping providers navigate complex insurance processes.
Responsibilities:
- Research and document prior authorization and benefit verification requirements across diverse payors (commercial plans, state Medicaid programs, etc.)
- Investigate payor-specific submission processes: required documents, portals, fax numbers, CPT code requirements, and policy updates
- Stay informed on payor policy changes, especially those affecting authorization processes and benefit structures
- Navigate payor websites, newsletters, and representative communications to gather accurate, up-to-date information
- Validate information from multiple sources and determine credibility of payor guidance
- Work independently to solve ambiguous problems where established processes don't yet exist
- Communicate findings clearly to cross-functional stakeholders and adapt quickly to feedback
- Handle tight deadlines and shifting priorities in a fast-paced startup environment
Requirements:
- Prior authorization and/or insurance verification experience at a healthcare clinic
- Deep familiarity with payor submission processes and how requirements vary across different insurance plans
- Strong research skills and comfort navigating payor portals, websites, and documentation
- Exceptional attention to detail and ability to spot common authorization mistakes
- Experience working with multiple payors and understanding process variations
- Demonstrated ability to build or improve processes when protocols don't exist
- Resilient problem-solver who thrives in ambiguous, evolving environments
- Strong communication skills and comfort asking for help when needed
- Humility and willingness to learn from mistakes
Benefits:
- Fully remote
- All necessary devices and system access provided
- Start date: ASAP
Similar Jobs
Research Analyst – VoC
Research Analyst focusing on customer experience research and VoC initiatives at an e-commerce company. Collaborating with cross-functional teams to drive insights and recommendations based on player feedback.
Study Start-Up Clinical Research Associate, Sponsor Dedicated
Study Start-Up Clinical Research Associate at IQVIA managing site selections and start-up activities for clinical trials. Collaborating with teams to ensure on-time delivery of study commitments while maintaining quality standards.
Freelance Clinical Research Associate
Freelance Clinical Research Associate managing clinical studies with pediatric monitoring experience. Join Rho in Bulgaria and ensure compliance with SOPs and regulatory requirements.
Clinical Research Associate, Sponsor Dedicated
Clinical Research Associate managing study sites and monitoring compliance under GCP guidelines. Collaborating with project teams to enhance predictability and execute studies efficiently.
Education Policy and Applied Research Analyst
Education Policy and Applied Research Analyst supporting LSAC’s mission through research and data insights. Collaborating with stakeholders to produce high-quality educational research and reports.
In-House Clinical Research Associate
In-House Clinical Research Associate at Rho managing clinical trial monitoring and data management activities. Collaborating with CRAs and project managers to ensure compliance with study protocols and regulations.
Senior Clinical Research Associate
Senior Clinical Research Associate ensuring integrity and quality in clinical trials for a growing CRO. Joining a collaborative team dedicated to addressing significant healthcare challenges.
Clinical Research Associate
Clinical Research Associate monitoring clinical trials for drug development at Praxis Precision Medicines. Ensuring compliance and conducting site management to improve patients' lives.
Bilingual Senior Clinical Research Associate
Manage clinical site monitoring services for multinational projects as Lead CRA. Responsible for design, oversight, and collaboration with stakeholders.
Desk Research Specialist
Senior Desk Research Specialist for Ek Kutumb conducting rigorous research into values and beliefs shaping communities across India. Anchoring secondary research and promoting informed policy design.
Qualitative Research Associate
Qualitative Research Associate at Ek Kutumb conducting research on social values and community beliefs. Engaging with diverse communities across India to gather qualitative insights on social change.
Research Associate, Survey – Education
Research Associate managing survey administration and project logistics for Hanover Research's growing enterprise. Collaborating with project managers and external vendors to streamline survey processes.
In-House Clinical Research Associate
In-House Clinical Research Associate at ICON plc supporting the execution and management of clinical trials. Contributing to innovative treatments and therapies.
Senior Research Consultant – On Call
On-call Senior Research Consultant providing expertise on workforce development and research. Collaborating with clients to lead and support strategic consulting projects in social issue areas.
Senior Clinical Research Associate, Site Manager
Senior Clinical Research Associate overseeing clinical trials in compliance with regulations. Collaborating with study centres and ensuring quality while managing study documentation and data validation.
Research Associate, SEPP
Research Associate contributing to projects in special education and policy evaluation at WestEd. Collaborating on research proposals and coordinating project management activities.
Research Associate – Teaching and Learning
Research Associate conducting educational research and evaluation projects at WestEd. Collaborating with teams to develop evidence-based solutions for special education and learner variability.
Property Research Analyst
Property Research Analyst supporting appraisal process with in-depth property research and data collection. Analyze market trends and work closely with appraisers to ensure data accuracy and completeness.
Senior Clinical Research Associate, Clinical Research Associate II
Senior Clinical Research Associate responsible for site management and monitoring of clinical trials across the US. Ensuring compliance and safety while enhancing investigator site relationships in line with GCP standards.
Research Associate I
Research Scientist maintaining and troubleshooting scientific research equipment in Antarctica for the National Science Foundation. Support diverse research projects while ensuring effective operation of scientific instrumentation.