Implementation Specialist - Prior Authorization

How this Role Makes an Impact

The Imagine team is a growing company, and we are inviting a motivated Implementation Specialist - Prior Authorization to join our talented team! This candidate will assist in preparation of data and ensure outstanding implementations with all our clients. This role is ideal for a candidate who is detail-oriented, highly motivated and who can quickly and efficiently solve client-related issues.

If you are looking for a place that offers a challenging and fast-paced environment with the opportunity to grow and develop, look no further! We are always looking for quality people to join our growing team. Must-haves include the ability to adapt to an ever-changing environment, work quickly and efficiently, continuously challenge the status quo, and be an innovative and solutions-based thinker.

Essential Duties

• Analyze and configure all data to meet specifications and coordinate development work with Prior Authorization Manager.
• Engage client vendors to identify inbound information and formats, document and map data formats from vendors to EE internal formats.
• Document any vendor web bots for mapping
• Identify any payer bot development and monitor progress.
• Document and manage the development of payer bots.
• Assists in testing during web bot development.
• Configure database in EE Payers and Facilitator
• Create any crosswalks needed for data.
• Provide developer mapped documentation for coding client specific requirements.
• Work with developer and 3^rd party vendors on testing formats, and configuration.
• Work with 3^rd party vendors to facilitate the necessary configuration, modifications and additions for processing prior authorization data automatically.
• Work with onshore and offshore vendors to implement and support manual prior authorization.
• Create workflow documentation for implementation for each client Assist with Support after transition to support person.
• Ensure outstanding implementations according to project timelines.
• Work in ticket queues for client implementation to monitor and resolve client issues and questions.
• Communicate clearly and effectively with clients, internal staff, and management to resolve issues and ensure customer satisfaction.
• Educate and train clients on initial Go-Live on how to effectively utilize products and services to achieve their goals.
• Properly escalate unresolved issues/requests to appropriate internal teams and ensure items are handled in a timely fashion.
• Research and diagnose clients' system issues during the implementation to identify and execute solutions for requests.
• Resolves client issues and provides support for prior authorizations during implementation.
• Participates in and manages special projects with an emphasis on reporting.
• Conducts regular client utilization reporting to understand product usage and client satisfaction.
• Other duties as assigned.

Education and/or Experience Needed

• 4-year degree preferred or 2+ years of medical related field

Qualifications You Must Have

Required:

• Proven ability to build and maintain relationships with clients
• Highly motivated, goal & detail oriented, and persistent personality
• Ability to understand and efficiently execute system-related solutions
• Ability to quickly learn technical material and apply new processes and technologies
• Ability to handle stressful situations and deadline pressures well
• Intermediate-to-Mastery level knowledge of basic Microsoft Office applications
• Flexibility to work with internal groups and external users
• High level of enthusiasm and initiative
• Ability to work well in a team environment
• Ability to work independently to meet deadlines and manage multiple projects
• Excellent written and oral communication skills
• Experience working with prior authorizations

Preferred:

• Familiarity with healthcare terminology and workflow
• Prior Authorization experience is a plus
• Knowledge of Healthcare Revenue Cycle Management process

Employment Type

• Full-Time, Exempt

Reporting Structure

• Lead Prior Authorization Specialist

Work Environment

Working conditions are normal for an office environment. Work may require occasional weekend and/or evening work and overnight travel up to 5%.

At ImagineSoftware, we have a role to play in contributing to an inclusive world. We work every day to lead with our values and beliefs that enable you to develop your potential and bring your full self to the workplace. Our culture of diversity and inclusion enables more creative thinking and better ideas for addressing a more diverse market. We hire driven people from all backgrounds because it makes us a great company, and because it's the right thing to do. If you share these values, you will find a home at ImagineSoftware.