Prior Authorization Representative

Qualified Recruiter, LLC; United States; On-site; USD 24,796 - 33,062; Full time

Job summary

A healthcare recruitment firm is seeking a Prior Authorization Representative to manage verification of prior authorization requirements and facilitate patient access to therapies. The ideal candidate will have strong customer service and communication skills, advanced Excel abilities, and basic knowledge of relevant coding. This role requires multitasking and attention to detail in a fast-paced environment.

Qualifications

• Strong communication skills to interact with physicians and payers.
• Advanced Excel skills and ability to handle multiple inquiries.
• Basic knowledge of ICD9/10 and CPT codes, with a focus on Medtronic therapy codes.

Responsibilities

• Verify prior authorization requirements and obtain necessary authorizations.
• Validate patient insurance coverage and communicate issues.
• Coordinate required paperwork and follow up on authorization statuses.

Skills

Customer service skills

Communication skills

Organizational skills

Problem-solving skills

Microsoft Excel

Tools

CRM software

Job description

Base Pay Range

$18.00/hr - $24.00/hr

Overview

The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. The role works directly with physician offices and payers to facilitate patient access to various therapies, ensuring patient insurance coverage and benefits, identifying requirements for prior approval, and submitting for authorization. The representative also assists with appealing prior authorization denials, retro authorizations, or other special cases.

Responsibilities Include, But Are Not Limited To

• Validates insurance patient’s coverage, communicates any issues with benefits or coverage to the appropriate managers
• Checks the requirements for prior authorization and initiates as required
• Coordinates required paperwork, clinical notes and forms for submission to support request and initiates as required
• Follows up frequently to ensure visibility on authorization status throughout the approval process
• Maintains basic knowledge of payer payment process with detailed knowledge of the payer prior authorization process
• Has basic ICD9/10 and CPT code familiarity, expert knowledge on subset of Medtronic therapy codes
• Provides superior customer service skills with outstanding communication skills to interact with various stakeholders, including physicians, sales representatives, payer representatives, utilization reviewers, and other internal and external stakeholders
• Has advanced Microsoft Excel skills and ability to learn and use multiple CRM software programs as needed
• Demonstrates good organizational skills with ability to handle multiple inquiries at the same time and critical problem‐solving skills with high attention to detail