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“Koya Medical, Inc.” Company Details
| Company Name | Koya Medical, Inc. |
| Rating | 4.2 / 5.0 |
| Job Type | Full-time |
| Job Position | Remote Position |
Authorization Specialist Job Overview
Submit requests for coverage to payers including network exceptions and single case agreements.
The Authorization Specialist is responsible for processing…
What to do in Koya Medical, Inc. company Job
Koya Medical has an immediate need for an Authorization Specialist who is interested in joining an organization at the ground floor (early commercialization phase). The Authorization Specialist is responsible for processing authorizations, certifications and referrals needed by payers to allow reimbursement at the highest level for patients and the organization. Key elements include the effective education of payers on company products and the ability to apply a strong knowledge of insurance to navigate the authorization process across numerous health insurance companies (payers). This position will report to the Lead Authorization Specialist in the Payor Operations team. The role is full time, exempt and will work remotely.
Description
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
- Submit requests for coverage to payers including network exceptions and single case agreements
- Review clinical documentation for medical necessity
- Secure and process authorizations and denials in timely manner
- Process submission of medical records and required documentation for approval of coverage
- Communicate findings of payer process in writing and verbally to appropriate team resource
- Maintain a high level of accuracy while meeting productivity and quality requirements
- Effectively educate payers on the features and benefits of the Company’s products
- Work with other departments to ensure accurate processing of patient orders and payer authorizations and denials
- Identify trends for process improvement and communicate to leadership
- Assist in the development of internal processes and best practices for the payer operations department
- Benefit and authorization process investigation
- Follow all compliance and HIPAA requirements
- Other duties as assigned
Minimum Qualifications
Education, Experience and Training
- Bachelor’s degree or equivalent work experience
- Previous experience in the medical device industry, payer process or related field
Knowledge, Skills and Abilities
- Strong level of proficiency with technology
- Service oriented
- Proven ability to work independently, multitask, prioritize and meet required deadlines
- Ability to be persuasive and credible with payers
- Working knowledge and expertise of insurance processes
- Technology savvy and able to navigate payer portal systems
- Ability to work independently and in collaboration with a team
- Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person
- Strong verbal and written communications skills
- High attention to detail
Core Competencies
- Change Agent
- Influencing
- Communication
- Process Management
- Priority Setting
- Peer Relationships
- Problem Solving
- Time Management
- Drive for Results
Tools and Technology
- Google Suite, Adobe, Salesforce CRM
Physical Functions and Work Environment
The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Note
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.
Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
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