About the Role

• The Prior Authorization Representative plays a crucial role in ensuring patient access to necessary therapies by verifying and obtaining prior authorization requirements.
• This position involves direct communication with physician offices and payers to facilitate the authorization process, ensuring that patients receive the therapies they need in a timely manner.

Responsibilities

• Validate patient insurance coverage and communicate any issues related to benefits or coverage to the appropriate parties.
• Check and initiate prior authorization requirements as needed.
• Coordinate and submit required paperwork, clinical notes, and forms to support authorization requests.
• Follow up frequently to maintain visibility on authorization status throughout the approval process.
• Utilize basic knowledge of payer payment processes and detailed knowledge of payer prior authorization processes.
• Apply basic familiarity with ICD9/10 and CPT codes, with expert knowledge on a subset of therapy codes.
• Deliver superior customer service and communicate effectively with various stakeholders, including physicians, sales representatives, payer representatives, and utilization reviewers.
• Utilize advanced MS Excel skills and learn multiple CRM software programs as needed.
• Demonstrate good organizational skills, handle multiple inquiries simultaneously, and apply critical problem-solving skills with high attention to detail.

Education Qualification

• A high school diploma or equivalent is required. Additional education or certification in healthcare administration or a related field is preferred.

Required Skills

• Strong communication and customer service skills.
• Advanced proficiency in MS Excel. 
• Familiarity with ICD9/10 and CPT codes.
• Ability to learn and use multiple CRM software programs.
• Excellent organizational skills and attention to detail.
• Strong problem-solving abilities and the ability to handle multiple tasks simultaneously.