Remote Prior Authorization Representative

Planet Pharma; Danbury (CT); Remote; USD 40,000 - 80,000; Full time

Job summary

An innovative firm is seeking a Remote Prior Authorization Representative to facilitate patient access to therapies by verifying insurance coverage and obtaining necessary authorizations. This role involves direct communication with physician offices and payers, ensuring a seamless process for patients. The ideal candidate will possess strong customer service and communication skills, along with a solid understanding of payer processes and prior authorization requirements. Join a diverse and inclusive environment where your contributions will make a significant impact on patient care and access to essential therapies.

Qualifications

• Basic understanding of payer payment processes and prior authorization.
• Ability to handle multiple inquiries with high attention to detail.

Responsibilities

• Verify prior authorization requirements and obtain necessary authorizations.
• Communicate issues with insurance coverage to managers.
• Coordinate paperwork and follow up on authorization status.

Skills

Prior Authorization Process Knowledge

ICD9/10 and CPT Codes Familiarity

Customer Service Skills

Communication Skills

Microsoft Excel Skills

Organizational Skills

Problem-Solving Skills

Tools

CRM Software

Job description

Remote Prior Authorization Representative

Join to apply for the Remote Prior Authorization Representative role at Planet Pharma.

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. The 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:

• Validate insurance coverage and communicate issues with benefits or coverage to the appropriate managers.
• Check requirements for prior authorization and initiate as required.
• Coordinate required paperwork, clinical notes, and forms for submission to support requests.
• Follow up frequently to ensure visibility on authorization status throughout the approval process.

Requirements:

• Basic knowledge of payer payment processes with detailed understanding of the payer prior authorization process.
• Familiarity with ICD9/10 and CPT codes; expert knowledge on a subset of company therapy codes.
• Superior customer service skills and outstanding communication skills to interact with physicians, sales representatives, payer representatives, utilization reviewers, and other stakeholders.
• Advanced Microsoft Excel skills and ability to learn and use multiple CRM software programs.
• Good organizational skills with the ability to handle multiple inquiries simultaneously and critical problem-solving skills with high attention to detail.

The Planet Group of Companies is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.