Client Services Analyst

Job Summary

A company is looking for a Client Services Analyst I (Fully Remote - USA).

Key Responsibilities

• Process incoming prior authorization and referral requests, ensuring accuracy and compliance with regulations
• Validate prior authorization requests against established policies and communicate discrepancies for investigation
• Monitor processing activities to ensure adherence to legal requirements and update systems with patient information

Required Qualifications, Training, and Education

• Experience in processing prior authorization and referral requests in a healthcare setting
• Proficient in interpreting EOB and UB-04 claim forms, with knowledge of medical coding (CPT, HCPCS, ICD-10)
• Familiarity with insurance payers and Medicaid policies
• Strong analytical skills to ensure data accuracy and resolve issues
• Proficient in Microsoft Excel, Visio, and PowerPoint