Remote Customer Service Rep II (Prior Authorization Representative)

Planet Pharma; Roseville (CA); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare organization in California is seeking a Prior Authorization Representative responsible for verifying prior authorization requirements and facilitating patient access to therapies. The role involves coordinating paperwork and communication with physician offices and payers for patient insurance coverage. Candidates should possess excellent customer service skills and have experience with insurance verification and the payer authorization process. Expertise in Microsoft Excel and organizational abilities are essential.

Qualifications

• Experience in verifying insurance patient’s coverage and communicating issues.
• Knowledge of ICD9/10 and CPT codes, particularly for Medtronic therapies.
• Ability to manage multiple inquiries with critical problem-solving skills.

Responsibilities

• Validate insurance patient’s coverage and communicate with managers.
• Check prior authorization requirements and initiate submissions.
• Coordinate paperwork and follow up on authorization status.

Skills

Insurance verification

Payer prior authorization process

Customer service skills

Advanced Microsoft Excel skills

Organizational skills

Tools

CRM software

Job description

The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. Representative will ensure patient insurance coverage and benefits, identify requirements for prior approval and submit for authorization. Assists with appealing prior authorization denials, retro authorization or other special cases

Responsibilities Include, But Are Not Limited To

• Validates insurance patient’s coverage, communicate 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
• Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of Medtronic therapy codes
• Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders,
• Advanced Microsoft Excel skills. Ability to learn and use multiple CRM software programs as needed
• Good organizational skills with ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail