Prior Authorization Assistant

📋 Description

• • Ascertain is at the forefront of revolutionizing healthcare administration by developing sophisticated AI agents designed to automate the burdensome administrative tasks that currently plague care teams. Our innovative solutions are already being implemented in major health systems and large specialty groups, where they are demonstrably saving hundreds of staff hours each week. We are backed by prominent organizations such as Northwell Health, New York's largest health system, and Deerfield Management, a leading healthcare investment firm. Our collective mission is to restore precious time, foster trust, and enable healthcare professionals to regain their focus on patient care, thereby alleviating the immense strain on the healthcare system. The urgency of our work stems not from typical startup timelines, but from the critical need of our customers to achieve financial resilience and operational clarity in an increasingly challenging environment.
• • As a Prior Authorization Assistant at Ascertain, you will be an integral part of our groundbreaking AI-powered prior authorization solution. This is a hands-on role tailored for individuals who excel in high-volume operational settings, adeptly balancing individual responsibilities with robust team support. You will be directly involved in processing prior authorizations, often at a significant volume, while simultaneously serving as a primary point of contact and a valuable resource for your fellow Ascertain Assistants. As our workflows become increasingly automated and seamlessly integrated with Ascertain’s advanced platform, this role is poised to evolve into a dynamic hybrid position encompassing both operations and technology expertise.
• • This is not a conventional, shift-based, desk-bound healthcare role. Instead, it is an outcome-driven position that places a premium on individual ownership, sound judgment, and unwavering follow-through. You will collaborate closely with Ascertain leadership and product teams, playing a pivotal role in shaping the future of prior authorization through the application of recent breakthroughs in artificial intelligence. This unique opportunity places you at the exciting intersection of healthcare operations and cutting-edge technology, allowing you to directly influence how administrative tasks are transformed.
• • Your day-to-day responsibilities will involve working closely with healthcare providers to significantly reduce administrative burdens and streamline complex workflows. This includes the manual processing of authorizations and the oversight of automated submissions for a wide array of services, such as office visit referrals, complex procedures, and pharmaceutical approvals. The role provides extensive exposure to diverse healthcare specialties, a variety of external stakeholders, and multiple departments across Ascertain, offering a comprehensive understanding of the healthcare ecosystem.
• • Key responsibilities include:
• • Meticulously reviewing and verifying insurance information and patient eligibility criteria to ensure compliance with all prior authorization requirements.
• • Proactively communicating with healthcare providers to efficiently gather all necessary medical documentation, clinical notes, and supporting information essential for authorization requests.
• • Accurately submitting prior authorization requests to various insurance companies, strictly adhering to established protocols and payer-specific guidelines.
• • Diligently monitoring and tracking the status of all authorization requests, ensuring timely processing and prompt resolution to minimize delays in patient care.
• • Professionally responding to inquiries from healthcare providers, patients, and insurance companies, providing clear and concise updates on authorization status and next steps.
• • Maintaining precise and organized records of all authorization requests, including approvals, denials, and any associated appeals or follow-up actions.
• • Collaborating effectively with internal Ascertain teams, including product, engineering, and customer success, to troubleshoot and resolve complex authorization issues, thereby driving continuous process improvement.
• • Staying consistently updated on evolving insurance policies, regulatory changes, and emerging industry trends pertinent to prior authorizations and healthcare administration.
• • Contributing to the development and refinement of our AI tools by providing valuable feedback on workflow automation and system performance.
• • Identifying and escalating potential process bottlenecks or systemic issues to leadership for strategic resolution.
• • Assisting in the training and onboarding of new team members, sharing best practices and operational knowledge.
• • Ensuring a high level of accuracy and compliance in all tasks performed, upholding Ascertain's commitment to quality and efficiency.