Job description

Summary

Altus Biologics is dedicated to Treating Each Patient Like Family through its management of the administrative aspects of our physician’s biologic therapy practices. We have a team environment that is filled with motivated, hard-working, and joyful employees ready to help our physicians and patients. Our clinical professionals are experienced and achieve desired results. Altus not only fosters opportunities for development, but also could provide you a real chance to make a difference in the lives of these patients.

Duties & Responsibilities

• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
• Documents specific details related to the authorization including approval number, valid dates, and number of visits using the appropriate system.
• Successfully work with payers via electronic/telephonic and/or fax communications.
• Responsible for verification and investigation of pre-certification, authorization, and predetermination requirements for services.
• Coordinates and supply information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Appropriately prioritize workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation regarding the process.
• Ensures timely and accurate insurance authorization are in place prior to services being rendered.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Receive requests for pre-authorizations and ensure that they are properly and closely monitored
• Process and submit medical records to insurance carriers to expedite prior authorization processes
• Manage correspondence with insurance companies, internal staff, and specialists as required
• Look through denials and submit appeals in a bid to get them approved from insurance companies

Qualifications

• High School Diploma or GED
• Three or more years working with prior authorizations
• Some travel may be required

Why work at Altus Biologics?

• Competitive Salary
• Daytime Hours
• Weekends Off
• Diverse Workforce
• One-on-One Patient Care
• Corporate & On-The-Job training
• Health Benefits
• Retirement Plan
• PTO

Altus Biologics provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting and hiring.

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