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Authorization Specialist

Evolent Health

This is a Full-time position in Carson City, NV posted October 3, 2022.

**Your Future Evolves Here**Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference _working_ in everything from scrubs to jeans.Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great place to work? Definitely. Evolent Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 Evolent in the U.S. was both named Best Company for Women to Advance list by Parity.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation’s foremost benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality.We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.**What You’ll Be Doing:**Responsible for verifying patient benefits for medical claim approval including obtaining prior-authorization and pre-certification when necessary. Adheres to department policies and procedures and complies with performance standards to ensure risk determinations and contract requirements are managed effectively. These activities are to be performed in compliance with federal, state and local laws as well as corporate policy. These individual projects a professional appearance and customer friendly demeanor at all times while maintaining the confidentiality of patient, coworker and facility information. This position at times works under stress and in situations that demand patience while providing impeccable service to all customers.Essential Duties and Responsibilities:+ Prioritizes incoming prior-authorization and pre-certification requests as outlined in departmental policies, procedures, and workflow guidelines.+ Contacts the health plan to gain plan information, verify active coverage, obtain all plan benefits as well as authorization requirements+ Communicates efficiently and professionally directly with facility or Account Management team to acquire all necessary documentation for case decisioning as well as provides this information to the health plans to ensure all requirements are met for authorization.+ Follows up timely and within department guidelines on all cases that are pending information and escalates cases as necessary if help is needed to obtain documentation.+ Receives inbound and makes outbound calls to healthcare professionals, commercial and workers’ comp carriers, and manufacturer sales representatives.+ Makes accurate, appropriate and timely case notes and database entries to ensure accurate and detailed case information.+ Refers requests that require clinical judgment to Underwriter Supervisor.+ Meets position metrics and turn-around timeframes using reports provided while maintaining a full caseload.+ Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.Experience we prefer:+ Previous health plan experience required.+ Two-year degree preferred or equivalent experience and job knowledge.+ Knowledge of medical terminology and coding.+ Excellent computer skills in Excel and Word.+ High level of attention to detail.+ Excellent organizational skills and communication skills.+ Requires at least one year of experience working prior-authorizations approvals with insurance companies.+ Experience conducting general carrier research and communicate discovered information timely to Underwriter Supervisor.+ Ability to work quickly and accurately on an independent basis with great attention to detail, and displaying initiative to quickly identify and resolve variances and discrepancies.+ Strong problem solver and skilled in conflict resolution.+ Strong computer literacy.+ Works well in a team environment.**Mandatory Requirements:**Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.**Preferred Requirements:**Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and national law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.​**Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status** .

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