HedgeHog Health is a tech-enabled behavioral health company providing both tools and autism therapy for families across the United States. Our mission is to empower parents and provide personalized care for children with autism by using technology to connect the dots between families, clinicians, insurers, and educators.
About the Role
The Prior Authorization Specialist will be responsible for performing all tasks regarding obtaining prior approvals from payers for our client s services.
- Manages daily work queues to ensure prior authorizations are submitted within the company policy and timeline
- Call payers and verify each client’s insurance benefits
- Identify and document each payer’s policy and procedures regarding coverage and items that require prior approval
- Identify and document each payers submission process
- Submit prior authorizations for approval
- Follow up with payers to check status of previously submitted prior authorizations
- Collaborate with care operations, clinical, and partnerships teams to resolve prior authorization denials
- Enter all documents, client data, new payer data, or responses regarding prior authorization into company systems
- Be highly responsive and communicate any changes in client’s prior authorization status to care operations, clinical, and partnerships teams.
- Experience in Behavioral Health (Preferred)
- Experience in Behavioral Health prior authorization processes (Preferred)
- Must be a self-starter with a strong sense of urgency and ability to proactively improve processes
- Must be a fast learner with the ability to read and understand payer responses and denials
- Must be very organized and able to establish priorities and drive results
- Must communicate professionally and effectively with all departments, clients, and insurance contacts
- Must take ownership and make a big, positive impact on team performanc