Match score not available

Prior Authorization Specialist

Remote:

Full Remote

Salary:

4 - 96K yearly

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

2+ years in prior authorizations or case management., Preferred experience in neurology or infusion., Understanding of healthcare insurance systems., Strong clinical terminology knowledge..

Key responsabilities:

Obtain pre-authorizations for medications and treatments.
Communicate with insurers and patients on authorizations.

Synapticure Inc. Startup https://synapticure.com/

11 - 50 Employees

See more Synapticure Inc. offers

Job description

About Synapticure As a patient and caregiver-founded company, Synapticure provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. Partnering with providers and health plans, including CMS' new GUIDE dementia care model, Synapticure is dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s and ALS.

The Role The Prior Authorization Specialist works closely with our care teams, patients and their families to ensure access to services and medication. The ideal candidate is excited about the idea of working closely with our provider and payer partners to ensure that the necessary pre-approvals (prior authorizations) are in place to confirm that medications and services are covered and reimbursable according to the patient’s health plan.

Job Duties - What you'll be doing

Collaborate with insurers to obtain pre-authorizations for condition-specific medications, diagnostic procedures and treatments, and support patients in navigating barriers / coverage and disputes.

Submit prior authorization requests for medical procedures, diagnostic tests, treatments, and medications as required by insurance providers.

Gather, review, and submit all necessary clinical documentation to support authorization requests, ensuring accuracy and completeness.

Communicate with insurance representatives to clarify requirements, resolve authorization denials, and follow up on pending approvals.

Collaborate with physicians, nurses, and other clinical staff to obtain additional clinical information or documentation required by insurance companies.

Inform patients about the status of their authorization requests, answer questions regarding coverage, and provide guidance on next steps.

Maintain accurate and detailed records of all prior authorization requests, outcomes, and patient information in compliance with HIPAA regulations.

Stay updated on changes in insurance policies, state and federal regulations, and organizational policies affecting prior authorizations and reimbursement.

Requirements – What we look for in you

2+ years of experience in prior authorizations, insurance coordination, or case management in a healthcare setting; preferred experience in neurology, radiology or infusion settings.

Preferred clinical experience and understanding of medical terminology

Understanding of healthcare insurance systems, especially for complex, long-term treatments.

Strong communication skills with the ability to explain complex medical and insurance information in an empathetic, patient-friendly manner.

Passion for patient advocacy with a problem-solving mindset, focusing on overcoming challenges to accessing care.

Ability to work effectively both independently and as part of a multidisciplinary team, including neurologists, health systems, independent providers, and insurers.

We’re founded by a patient and caregiver, and we’re a remote-first company. This means our values are at the heart of everything we do, and while we’re located all across the country, these principles are what tie us together around a common identity:

Relentless focus on patients and caregivers. We are determined to provide an exceptional experience for every patient we have the privilege to serve, and we put our patients first in everything we do.

Embody the spirit and humanity of those living with neurodegenerative disease. Inspired by our founders, families and personal experiences, we recognize the seriousness of our patients’ circumstances, and meet that challenge every day with empathy, compassion, kindness, joy, and most importantly – with hope.

Seek to understand, and stay curious. We start by listening to one another, our partners, our patients and their caregivers. We communicate with authenticity and humility, prioritizing honesty and directness while recognizing we always have something to learn.

Embrace the opportunity. We are energized by the importance of our mission, and bias toward action.

Benefits for full-time employees

Remote-first design with work from home stipend

Competitive compensation with an annual bonus opportunity

401(k) with matching contribution from day 1

Medical, Dental and Vision coverage for you and your family

Life insurance and Disability

Generous sick leave and paid time off

Fast growth company with opportunities to progress in your career

Travel Expectations

This role would be expected to travel <10% to attend company gatherings, primarily in Chicago