Job Details

At Bridge Health, we streamline access to care by making it easy to check patient eligibility and submit prior authorizations. 

Our platform reduces administrative burdens, accelerates access to care, and improves outcomes for patients. We’re looking for a Prior Authorization & Eligibility Specialist to join our growing team to check patient benefits and submit prior authorization requests. 

Role Overview
As a Prior Authorization & Eligibility Specialist, you will work directly with payers and healthcare providers to verify patient benefits and obtain prior authorizations for medical services and specialty medications. You’ll collaborate closely with our operations teams to ensure that our workflows are efficient and effective. 

Key Responsibilities

• Verify patient insurance eligibility and benefits for physical therapy services.

• Submit and follow up on prior authorization requests with commercial, Medicare, and Medicaid payers.

• Communicate with insurance companies, providers, and pharmacies to resolve issues or obtain additional information.

• Track prior authorization statuses and ensure timely approvals to avoid delays in patient care.

• Identify payer-specific requirements and provide feedback to improve operational workflows.

• Escalate complex cases as needed and assist in resolving denials or appeals.

• Maintain accurate and timely documentation in internal systems and payer portals.

Qualifications

• 2+ years of hands-on experience with eligibility verification and prior authorization processing for healthcare providers, or payers, ideally with experience in PT, OT, SLP. 

• Proficiency with payer portals and clearinghouses (e.g., Availity).

• Strong knowledge of payer requirements.

• Excellent communication and problem-solving skills.

• Highly organized and able to manage multiple cases simultaneously.

• Comfortable using technology platforms and adapting to new tools.