Pay Range: $20/hr -$23

About the Role

• The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining necessary authorizations to facilitate patient access to various therapies.
• This role involves direct communication with physician offices and payers to ensure patient insurance coverage and benefits are in place, identifying requirements for prior approval, and submitting authorization requests.
• The representative also assists with appealing prior authorization denials, retro authorizations, or other special cases.

Responsibilities

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

Education Qualification

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

Required Skills

• Superior customer service and communication skills.
• Advanced proficiency in MSt Excel.  Familiarity with ICD9/10 and CPT codes.Ability to learn and use multiple CRM software programs.
• Strong organizational and problem-solving skills.
• High attention to detail.

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 off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.