Prior Authorization Representative

Quadax, Inc.; Middleburg Heights (OH); Hybrid; USD 26.000 - 30.000; Vollzeit

Zusammenfassung

Quadax, Inc. is hiring for a position focused on medical prior authorization and insurance billing. The role requires transitioning from onsite training in Middleburg Heights, Ohio to remote work after an initial 3-month period.

The ideal candidate has a high school diploma or GED, health insurance billing experience, familiarity with medical terminology, and strong attention to detail. Proficiency in Excel and Word, plus excellent communication, is required. Salary range: $19–$22 per hour.

Qualifikationen

• High School diploma or GED.
• Health insurance billing experience.
• Working knowledge of medical terminology.
• Proficient and attentive to details.
• Excellent written and verbal communication skills.
• High attention to detail.
• Ability to maintain confidentiality.
• Proficient in using Microsoft Excel and Word.
• Ability to multitask, establish priorities, and work independently.

Aufgaben

• Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.
• Navigate through payer portals to initiate/obtain prior authorization status.
• Provide insurance company representatives with an overview of the services being submitted for prior authorization.
• Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
• Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.
• Follow up with the insurance company or physician’s office as needed.
• Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.
• Participate in team meetings by sharing the details of cases worked.
• Comply with all applicable SOPs.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Kenntnisse

Communication skills

Multitasking

Attention to detail

Confidentiality

Independent work

Ausbildung

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Jobbeschreibung

Remote: Although this position is listed as remote, the training period requires you working onsite 5 days/week for 3 months at our Middleburg Heights, Ohio facility before transitioning to remote. Due to business requirements, only applicants residing in Ohio will be considered.

Key Responsibilities:

• Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.


• Navigate through payer portals to initiate/obtain prior authorization status.


• Provide insurance company representatives with an overview of the services being submitted for prior authorization.


• Answer questions regarding the reimbursement process and direct testing specific and treatment questions.


• Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.


• Follow up with the insurance company or physician’s office as needed.


• Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.


• Participate in team meetings by sharing the details of cases worked.


• Comply with all applicable SOPs.


• Meet or exceed productivity and quality KPI goals.


• Perform other duties as assigned.

Education/Experience:

• High School diploma or GED


• Previous health insurance billing experience


• Working knowledge of medical terminology


• Proficient and attentive to details


• Excellent written and verbal communication skills


• High attention to detail


• Ability to maintain confidentiality


• Proficient in using Microsoft Excel and Word


• Ability to multitask, establish priorities, and work independently

Salary Range: $19-$22 per hour

Equal Opportunity Employer
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