Prior Authorization Support Representative

DrFirst; 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 collaborating with healthcare providers and payers. Ideal candidates will have a background in healthcare and strong communication skills. Opportunities for growth and competitive hourly compensation are offered.

Qualifications

• Previous experience in healthcare, insurance, or related field.
• Relevant certifications in healthcare or utilization management are a plus.

Responsibilities

• Act as primary contact between providers, payers, and internal teams.
• Assist in completing clinical questionnaires for prior authorization.
• Manage urgent and expedited requests with attention to timelines.

Skills

Communication

Interpersonal Skills

Detail-oriented

Organizational Abilities

Data Analysis

Medical Terminology

Education

Associate or Bachelor’s degree

Job description

About DrFirst

This is a great opportunity to be a part of a successful Healthcare IT company experiencing significant growth. We have proven products that address the leading causes of gaps in patient care, brand-name customers, significant growth opportunities and are backed by leading investors. Here you'll get to work with some of the smartest and most interesting people around; solving unique and complex challenges in healthcare on a scale matched by few companies.Over 300,000 healthcare professionals, 67,000 pharmacies and 60% of the healthcare IT vendors in the market depend on us every day to help them improve patient outcomes and reduce risk, by managing medication safety and efficiency, reducing clinical errors, and eliminating or overcoming the barriers to effective communication both within and outside healthcare facilities and organizations.Our culture is entrepreneurial, team oriented, collaborative, and fast-paced. If you get excited about stretching yourself in new ways, developing yourself to your fullest potential, and care about working with smart colleagues; we want to talk to you!

Position Overview

The Prior Authorization (PA) Support Representative will be a dedicated Subject Matter Expert (SME) in utilization management, responsible for ensuring smooth and timely processing of prior authorization requests. This role involves direct communication and collaboration with ordering provider's offices, payers, and other stakeholders through phone calls, faxes, and direct connections where applicable.

What you will work on

• Communication & Collaboration: Act as the primary point of contact between providers, payers, and internal teams to facilitate the prior authorization process.

• Clinical Questionnaire Completion: Assist in completing clinical questionnaires presented by the payer following the initial submission of a prior authorization request to alleviate the burden on the provider’s office and ensure accuracy.

• Proactive Error Management: Address and rectify errors, such as missing information (e.g., height, weight, previously tried and failed medications), to prevent unnecessary rejections and ensure swift processing of authorization requests.

• Urgent Request Handling: Manage urgent and expedited requests with attention and urgency to meet critical timelines.

• Denial Management: Provide solutions and alternatives in cases of payer denials, including assisting with appeals when possible.

• Reporting & Analysis: Utilize advanced reporting tools to track trends, approval rates, and other key metrics, offering data-driven support and strategic, tailored processes and solutions based on specific drugs and therapeutic areas of interest.

• Outbound Engagement for Pilot Initiatives: Make outbound phone calls to pharmacies or provider offices as part of pilot programs, supporting cross-functional efforts that may fall outside typical prior authorization activities.

• Flexibility in Support Tasks: Participate in special projects or initiatives outside of core PA functions when needed, including pharmacy coordination or other operational support, while maintaining high standards of professionalism and accuracy.

Qualifications

• Education: Associate or Bachelor’s degree in a related field preferred.

• Experience: Previous experience in healthcare, insurance, or a related field, with a focus on prior authorizations or utilization management.

• Skills:

• Strong communication and interpersonal skills.

• Detail-oriented with excellent organizational abilities.

• Ability to manage multiple tasks and priorities in a fast-paced environment.

• Proficiency with reporting tools and data analysis.

• Familiarity with medical terminology and clinical documentation.

• Certifications: Relevant certifications in healthcare or utilization management are a plus.

*Bonus if:

• You are a licensed healthcare professional (e.g., registered nurse, CNA, medical assistant).

• You have experience working directly with patients in a clinical setting, providing care, and understanding medical terminology and procedures requiring prior authorization.

Work Environment:

• Setting: This is a remote role and must be located within the United States.

• Schedule: Full-time, with the ability to handle urgent requests outside of regular business hours as needed.

• Tools: Use of phone, fax, computer, and reporting software for daily tasks.

Additional Information:

• Compensation: This is a consultant role with an hourly salary.

• Opportunities for Growth: Career advancement opportunities within the utilization management and healthcare administration fields.

• The PA Support Representative plays a crucial role in ensuring that prior authorization requests are processed efficiently, accurately, and in a timely manner, thereby enhancing the overall healthcare delivery process.

Physical Requirements

• This role is 100% remote.

• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
• Specific vision abilities required by this job include close vision requirements due to computer work.

#LI-GF1 #LI-Remote

Benefits

We are looking for a highly motivated and results-oriented individual to join our growing team. If you are passionate about the customer experience and have a strong technical background, we encourage you to apply!

• This role will be fully remote and will start off as a long term contract position with competitive hourly compensation of $20 - $25 per hour.

DrFirst is committed to being a Remote-First company, creating a dynamic and flexible workplace where everyone can thrive, no matter where they log in from. Check out our approach to remote workhttps://drfirst.com/company/about-us/careers/.

Our recruitment process at DrFirst is straightforward and secure. You will only be contacted by our recruitment team through an [e-mail] address.We will never ask you for payment or sensitive personal information, such as your social security number or banking details, at any stage of the hiring process. Additionally, we will not request that you purchase equipment or accept e-checks or checks for deposit.If you encounter any communications claiming to be from DrFirst that seem suspicious, please contact our recruitment team directly [e-mail] verify the message's authenticity. Your security is important to us!

Learn more about our benefits and professional development opportunitieshttps://drfirst.com/company/about-us/careers/the-perks/.