Prior Authorization -Insurance Verification Specialist

Sparks Group has partnered with a We're seeking a behavioral health care and social services agency located in Washington, DC.  Together we are recruiting for a detail-oriented Prior Authorization- Insurance Verification Specialist to join the team.

Responsibilities:

• Initiate new prior authorization requests with providers.
• Find the correct forms based on patient insurance
• Verify patient insurance and Medicaid eligibility for service dates.
• Collaborate with prescribers and offices for accurate forms.
• Track request status and follow up with medical offices.
• Communicate authorization status to patients and providers.
• Manage appeals with medical offices.
• Answer internal inquiries about prior authorization requests.
• Verify insurance coverage and interact with insurance companies
• Explain insurance coverage and potential out-of-pocket costs to patients.
• Maintain organized records of insurance verification and authorizations.
• Stay updated on insurance policies and procedures for compliance.

Qualifications:

• High school diploma or GED (Associate degree a plus).
• Proficient in insurance verification processes.
• Prior customer service or call center experience required.
• Working knowledge of Microsoft Office Suite and experience with insurance portals (e.g., DC Medicaid EVS, AmeriHealth, Amerigroup, Medstar).
• Excellent written and verbal communication skills.
• Strong technical skills, analytical thinking, and attention to detail.
• Passion for patient care and teamwork.
• Ability to work flexible shifts (8:30 am - 5:00 pm).

Preferred Qualifications:

• 1+ year experience with pharmacy prior authorizations.
• 1-3 years of experience in patient registration or insurance verification.

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This job is In-Person.

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Sparks Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, pregnancy, citizenship, family status, genetic information, disability, or protect veteran status.