Prior Authorization Specialist Job at TekWissen LLC, Detroit, MI

  • TekWissen LLC
  • Detroit, MI

Job Description


TekWissen Group is a workforce management provider throughout the USA and many other countries in the world. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Prior Authorization Specialist

Work Location: Detroit, MI, 48243

Duration: 12 Months

Job Type: Contract

Work Type: Onsite Training and later Remote

Dept: UM Program Mgmt

Engagement Description:

  • Support client providers and UM reviewers with prior authorization requests for post-acute care services.

  • Includes manually entering authorization requests into client Care Management systems, following rules and algorithms embedded in the care management system to administratively approve prior authorization requests.

  • May work with providers to secure discharge plans, Notice of Non-Medical Coverage, Durable medical equipment, and other home supports required for discharge planning.

  • May support scheduling physician to physician calls.

  • Will support appeal processes for CMS designated Quality Improvement Organization appeals including logging all appeal activities.

  • High School Graduate or GED equivalent required.

  • Two (2) years of college preferred.

  • Two (2) years experience as medical assistant, care technician, post-acute care and home health care support staff or ancillary services in other health care related field preferred.

  • Knowledge post-acute care functions and processes or discharge readiness activities may be preferred for some positions.

TekWissen Group is an equal opportunity employer supporting workforce diversity.

Job Tags

Contract work, Remote job,

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