Human Resources

• Verify active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across commercial plans
• Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.)
• Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40+ states
• Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless
• Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations
• Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics
• Act as the go-to resource for clinical teams when a payer's prior-authorization process is vague, contradictory, or unmapped
• Validate conflicting information from multiple insurance sources to determine the most credible, risk-free path for claim submission
• Build, update, and maintain internal state-by-state reference guides on commercial insurance and state-by-state regulatory requirements
• Prepare clear, professional patient insurance benefit letters outlining estimated out-of-pocket costs and referral requirements
• Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps
• Help de-escalate patient or provider concerns regarding coverage limits with professional, empathetic communication

Eligibility, Benefits, Prior Authorization Specialist

• Act as a key HR point of contact, providing end-to-end support across the employee lifecycle - from onboarding and 1:1 check-ins to performance reviews and offboarding - ensuring smooth and effective people operations;
• Partner closely with managers to lead and embed robust Performance Management practices, aimed at strengthening individual and team impact;
• Provide strategic guidance and day-to-day coaching to managers, helping them grow as people leaders and navigate HR-related challenges with confidence;
• Participate in the hiring process, assessing cultural fit, alignment with values, and role expectations before offers are made;
• Collaborate with the Learning & Development team to identify development needs and align growth efforts with business priorities;
• Monitor and enhance employee satisfaction and engagement, surfacing insights and driving action in partnership with business leaders;
• Contribute to HR analytics by collecting and interpreting data to inform workforce strategy, performance trends, and team dynamics;
• Assisted recruiters throughout the hiring process and contributed to the recruitment of new specialists.

HR Generalist

• Manage the hiring process, which includes writing job descriptions, posting openings, screening candidates, coordinating interviews, and guiding new hires through onboarding, orientation, and offboarding activities
• Act as a point of contact for staff and managers, address staff concerns, conduct basic investigations, and help resolve conflicts
• Maintains awareness of benefits programs, such as health insurance and retirement plans, and understands payroll and compensation practices
• Supports performance evaluation processes, provides coaching to managers in regards to goal-setting, and assists with performance improvement plans
• Ensures organizational compliance with all federal, state, and local employment laws and regulations, and helps enforce HR policies
• Proficiently navigates HR systems; pulls reports; analyzes HR data to help make informed decisions

Human Resources jobs in Worldwide

See all jobs on JobTailor

Eligibility, Benefits, Prior Authorization Specialist

HR Generalist

Human Resources Generalist