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Referral & Prior Authorization Associate

Parsley Health

Parsley Health

This job is no longer accepting applications

See open jobs at Parsley Health.
Remote
Posted on Saturday, January 20, 2024

About us:

Parsley Health is a digital health company with a mission to transform the health of everyone, everywhere with the world's best possible medicine. Today, Parsley Health is the nation's largest health care company helping people suffering from chronic conditions find relief with root cause resolution medicine. Our work is inspired by our members’ journeys and our actions are focused on impact and results.

The opportunity:

The Referral & Prior Authorization Coordinator will be a key member of the Clinical Operations Team at Parsley Health and responsible for supporting members with referrals as well as identifying prior authorization requirements by insurance/payer and ensuring our B2B members have a streamlined referral experience. They will be responsible for processing and completing all prior authorizations requested by the clinical team on behalf of the patient; i.e. for procedures, medications, lab work etc. They will also be responsible for supporting members when necessary in the event a lab order was not covered by their insurance. We are looking for people excited to grow with us!

This role reports into our Clinical Operations Manager. This is a FTE, non-exempt position.

What you’ll do:

  • Manage referrals for members by finding a specialist in-network with the member’s insurance and coordinating the appointment.
  • Ensure all clinical documentation from patient visits outside of PH are returned to the appropriate clinical team.
  • Follow up with the members post-visit to ensure they were able to attend the appointment.
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
  • Manage correspondence with insurance companies, physicians, specialists, and patients as needed.
  • Manage requests for prior authorization through the electronic health record (EHR) and/or via phone/email/fax to ensure that they are properly processed in a timely fashion and closely monitored.

Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow up is performed.

  • Review accuracy and completeness of information requested and ensure that all supporting documents are present.
  • Support patients with unexpected large lab bills by consulting with clinician and providing lab with appropriate ICD-10 codes and/or letters of medical necessity.
  • Create medical invoices for potential reimbursement for membership fees for out-of-network members.
  • Draft FSA/HSA letters for members when necessary.
  • Track data on approvals and denials for referrals and authorizations Parsley wide.
  • Assisting with creating SOPs and workflows as they relate to Referrals/Insurance/PAs.
  • Process and send appeals to appropriate entities in a timely fashion.

What you’ll need:

  • 2+ years in health care processing of prior authorizations and insurance
  • Bachelor’s degree or equivalent preferred
  • Knowledge of insurance process and medical terminology.
  • Excellent oral and written communication skills.
  • Demonstrable attention to detail with a knack for organization and clarity.
  • Flexibility; things change often and we need someone who can adapt quickly.
  • Professional, but friendly demeanor.
  • A sense of ownership of assigned tasks, and always look for the best solution.

Benefits and Compensation:

  • Equity Stake
  • 401(k) + Employer Matching program
  • Remote-first with the option to work from one of our centers in NYC or LA
  • Complimentary Parsley Health Complete Care membership
  • Subsidized Medical, Dental, and Vision insurance plan options
  • Generous 4+ weeks of paid time off
  • Annual professional development stipend

Parsley Health is committed to providing an equitable, fair and transparent compensation program for all employees.

The starting salary for this role is between $55,250 - $65,000, depending on skills and experience. We take a geo-neutral approach to compensation within the US, meaning that we pay based on job function and level, not location.

Individual compensation decisions are based on a number of factors, including experience level, skillset, and balancing internal equity relative to peers at the company. We expect the majority of the candidates who are offered roles at our company to fall healthily throughout the range based on these factors. We recognize that the person we hire may be less experienced (or more senior) than this job description as posted. If that ends up being the case, the updated salary range will be communicated with candidates during the process.


At Parsley Health we believe in celebrating everything that makes us human and are proud to be an equal opportunity workplace. We embrace diversity and are committed to building a team that represents a variety of backgrounds, perspectives, and skills. We believe that the more inclusive we are, the better we can serve our members.


Important note:

In light of recent increase in hiring scams, if you're selected to move onto the next phase of our hiring process, a member of our Talent Acquisition team will reach out to you directly from an @parsleyhealth.com email address to guide you through our interview process.

Please note:

  • We will never communicate with you via Microsoft Teams
  • We will never ask for your bank account information at any point during the recruitment process, nor will we send you a check (electronic or physical) to purchase home office equipment

We look forward to connecting!

#LI-Remote

This job is no longer accepting applications

See open jobs at Parsley Health.