Prior Authorization Support Representative

DrFirst, Inc.; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

Join a leading Healthcare IT company as a Prior Authorization Support Representative. This remote role involves managing prior authorization requests, ensuring timely processing, and supporting healthcare professionals. Ideal candidates are detail-oriented, possess strong communication skills, and have a background in healthcare or utilization management. Opportunities for career growth are available in this dynamic environment.

Qualifications

• Experience in healthcare, insurance, or utilization management.
• Knowledge of medical terminology and clinical documentation.
• Licensed healthcare professional preferred.

Responsibilities

• Act as primary contact for providers and payers for prior authorization.
• Assist in completing clinical questionnaires for payers.
• Use reporting tools to analyze trends and provide insights.

Skills

Communication

Detail-oriented

Organizational Skills

Data Analysis

Interpersonal Skills

Education

Associate or Bachelor’s degree

Tools

Reporting Software

Phone

Fax

Computer

Job description

Prior Authorization Support Representative

Join to apply for the Prior Authorization Support Representative role at DrFirst, Inc.

This is a great opportunity to be part of a successful Healthcare IT company experiencing significant growth. We have proven products that address key gaps in patient care, serve brand-name customers, and offer substantial growth opportunities, backed by leading investors. Work with some of the smartest people in healthcare, solving complex challenges at scale.

Over 300,000 healthcare professionals, 67,000 pharmacies, and 60% of healthcare IT vendors depend on us daily to improve patient outcomes by managing medication safety, reducing clinical errors, and enhancing communication within and outside healthcare facilities.

Our culture is entrepreneurial, team-oriented, collaborative, and fast-paced. If you thrive on new challenges, personal development, and working with smart colleagues, we want to hear from you!

Position Overview

The Prior Authorization (PA) Support Representative will be a Subject Matter Expert in utilization management, ensuring smooth and timely processing of prior authorization requests through direct communication with providers, payers, and stakeholders via phone, fax, and other channels.

What You Will Work On

• Act as the primary contact for providers, payers, and internal teams to facilitate prior authorization.
• Assist in completing clinical questionnaires for payers to reduce provider burden and ensure accuracy.
• Address errors like missing info to prevent rejections and expedite requests.
• Manage urgent requests with attention and urgency.
• Support denial management and appeals when necessary.
• Use reporting tools to analyze trends, approval rates, and other metrics, providing data-driven insights and process improvements.
• Make outbound calls for pilot initiatives, supporting cross-functional efforts.
• Participate in special projects outside core functions, maintaining professionalism and accuracy.

Qualifications

• Associate or Bachelor’s degree preferred.
• Experience in healthcare, insurance, or utilization management.
• Strong communication and interpersonal skills.
• Detail-oriented with good organizational skills.
• Ability to multitask in a fast-paced environment.
• Proficient in reporting tools and data analysis.
• Knowledge of medical terminology and clinical documentation.
• Relevant healthcare or utilization management certifications are a plus.
• Licensed healthcare professional (e.g., RN, CNA, medical assistant).
• Experience working directly with patients and understanding medical procedures requiring prior authorization.
• This is a remote role within the United States.
• Full-time schedule, with availability for urgent requests outside normal hours.
• Tools: Phone, fax, computer, reporting software.

Additional Information

• Compensation: $20-$25/hr, long-term contract.
• Opportunities for career growth in utilization management and healthcare administration.
• The role is key in ensuring efficient, accurate prior authorization processing to improve healthcare delivery.

Physical Requirements

• 100% remote role.
• May require sitting, standing, talking, hearing, reaching, and using hands for computer work.
• Close vision needed for computer tasks.

We seek highly motivated, results-oriented individuals passionate about customer experience and technical proficiency. If interested, apply now!

• This is a remote, long-term contract position with competitive hourly pay.

DrFirst is a Remote-First company committed to a flexible workplace. Learn more about our remote work approach at https://drfirst.com/company/about-us/careers/.

Our recruitment process is secure and straightforward. You will only be contacted via an official @drfirst.com email. We will never ask for payment or sensitive info, nor request equipment purchases or deposits. If suspicious contacts occur, verify by emailing [e-mail].

Discover our benefits and professional development opportunities at https://drfirst.com/company/about-us/careers/the-perks/.