Patient Access & Prior Authorization Specialist, AI Contact Center
Overview
You own the human-in-the-loop role for AI-driven patient access and insurance verification, guiding live calls between healthcare reps and insurance agents. Your work ensures accurate documentation and smooth prior auth across the reimbursement cycle. You collaborate with a team of specialists while training AI systems through real-time inputs. This role stands out by blending healthcare expertise with next-gen AI tools, offering a contract-to-hire remote position in a high-growth environment.
What You'll Do9
- 1Monitor AI-led agent-to-agent conversations, verifying accuracy and continuity for insurance verification and prior authorization details.
- 2Guide AI interactions by selecting appropriate prompts, responses, and next steps during live calls.
- 3Take over calls when the AI cannot respond, when an agent prefers a human, or when carrier or contract requires human interaction.
- 4Review prior conversation notes to pick up where another specialist or the AI left off, maintaining a seamless experience.
- 5Conduct insurance verification by confirming eligibility, benefits, and coverage with insurance agents.
- 6Gather and document prior authorization information, performing follow-up activities as needed.
- 7Capture complete and accurate data before concluding each call, updating internal systems with all interaction details.
- 8Manage both outbound and inbound call workflows, using AI tools and multiple computer systems simultaneously.
- 9Follow established processes and scripts while remaining solution-oriented, collaborating with AI technology to improve system performance.
Requirements12
- 16+ months of customer service experience in a call center or similar environment.
- 2High School Diploma or GED.
- 3Basic computer proficiency and ability to learn new systems, including Microsoft Office.
- 4Proven data entry and documentation skills with strong attention to detail.
- 5Experience navigating multiple systems and screens simultaneously.
- 6Strong listening, comprehension, and verbal communication skills.
- 7Solution-oriented mindset with ability to resolve issues and follow through.
- 8Ability to work independently while following directions and processes.
- 9Capability to quickly absorb information from previous notes and continue conversations.
- 10Comfort working in healthcare-related environments, including insurance verification and prior authorization support.
- 11Familiarity with call center operations, call monitoring, and call support.
- 12Experience with healthcare administrative roles, such as Medical Office Assistant or Patient Access Representative.
Salary Insight
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