Pay Range: $20/hr-$21/hr

Benefits:
The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, (paid time , paid sick and safe time , hours of paid vacation time, weeks of paid parental leave, paid holidays annually - AS Applicable)

About the Role

• The Prior Authorization Representative plays a crucial role in ensuring patients have access to necessary therapies by verifying and obtaining prior authorizations.
• This position involves direct communication with physician offices and payers to facilitate patient access to treatments.
• The representative will manage patient insurance coverage, identify prior approval requirements, and handle authorization submissions.
• Additionally, the role includes assisting with appeals for prior authorization denials and managing special cases.

Responsibilities

• Validate patient insurance coverage and communicate any issues with benefits or coverage to relevant parties.
• Check and initiate prior authorization requirements as needed.
• Coordinate and submit necessary paperwork, clinical notes, and forms to support authorization requests.
• Frequently follow up to ensure visibility on authorization status throughout the approval process.
• Maintain a basic understanding of payer payment processes and detailed knowledge of payer prior authorization processes.
• Familiarity with ICD9/10 and CPT codes, with expert knowledge of specific therapy codes.
• Provide superior customer service and communication with various stakeholders, including physicians, sales representatives, payer representatives, and utilization reviewers. 

Education Qualification

• Relevant educational background in healthcare administration, medical billing, or a related field is preferred.