Prior Authorization Representative

Quadax; United States; Remote; USD 26,000 - 30,000; Full time

Job summary

Quadax is seeking a detail‑oriented professional to support prior authorization workflows for health plans. The role combines remote work with an initial onsite training period in Middleburg Heights, OH, ensuring compliance with SOPs and KPI targets.

Applicants must reside in Ohio and have billing experience. Responsibilities include handling payer portals, preparing LOMN forms, and coordinating with insurers and physicians to secure authorizations.

Qualifications

• High School diploma or GED required.
• Previous health insurance billing experience preferred.
• 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 Microsoft Excel and Word.
• Ability to multitask, establish priorities, and work independently.

Responsibilities

• Review case and insurance information to customize prior authorization requests.
• Navigate payer portals to initiate/obtain authorization status.
• Provide overview of services being submitted for prior authorization to insurers.
• Answer questions regarding reimbursement processes and testing/treatment specifics.
• Complete LOMN forms as required and fax to physicians.
• Follow up with insurers or physician offices as needed.
• Meet productivity and quality KPI goals.
• Participate in team meetings and share case details.
• Comply with SOPs and company policies.
• Perform other duties as assigned.

Skills

Attention to detail

Excellent communication

Multitasking

Education

High School diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

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