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Medical Claims Specialist

Jul 11, 2022

When you think about the work environment at a company in the Healthcare industry, what comes to mind?  Here at PRIA, we offer the opposite of what you’re picturing!

We are passionate about our work and our people. We know that a company is nothing more than the people who are fortunate enough to call PRIA home.

Our work environment ensures that you won’t wake up dreading another day at the office.

If you consider yourself to be extraordinary, we want to talk to you!  Find out what makes PRIA one of Connecticut’s “Best Places to Work

What’s in it for you?

– Competitive compensation and annual merit increase
– Starting with 4 weeks of PTO
– Medical/Dental/Vision
– 401K with 3% match
– Progressive company culture
– Casual dress code
– Employee health & wellness programs
– Employee events and community involvement

We also offer our employees training opportunities including tuition reimbursement, career development courses and a very aggressive employee referral program.

PRIA Healthcare Management is a patient access and reimbursement solutions company specializing in patient-based appeals of denied care.

We are currently looking for a Prior Authorization Specialist that is ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service.

Experience working with insurance appeals and the prior authorization process is preferred. Knowledge of medical reimbursement policies within a healthcare organization is preferred. Previous Medical Billing experience and/or Certified Coding Specialists are a plus.

Job Responsibilities

  • Data enter new patient cases into system database
  • Gather supporting documentation from physician offices and facilities (i.e. patient medical records, consent forms, insurance correspondence) to support authorization or appeal request
  • Submission of prior authorizations and appeals with commercial insurance
  • Submission of post-service claim appeals with commercial insurance and Medicare
  • Complete eligibility and verification of benefits
  • Draft letters to support authorizations and appeals specific to each patient
  • Follow up with payers over the phone to get status of cases/decisions
  • Communicate with physician’s office and their staff regularly
  • Provides exceptional customer service to patients and providers
  • Comply with HIPAA laws and company policies and procedures

Required Skills:

  • Experience working with insurance claims, appeals, prior authorizations and is preferred
  • Experience with Medicare, Medicaid, Tricare, Workers Compensation and Commercial Insurance
  • Attention to detail and deadlines
  • Expertise in CRM software or databases is a plus
  • Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees
  • Must be proficient in Microsoft Office
  • Must demonstrate excellent communication skills, verbal and written.

This position will work out of a new location in Hartford/West Hartford that has not yet opened.

Location: Torrington, CT

Apply Now