Tech I - Prior Authorization

SGS Consulting; Richardson (TX); On-site; USD 35,000 - 45,000; Full time

Job summary

A healthcare service provider in Richardson, Texas is seeking a Customer Service Representative with a focus on prior authorization processes. The candidate must have at least three years of experience in a customer service role, preferably in healthcare or social services. Responsibilities include handling inbound calls, maintaining documentation, and providing professional assistance to callers. A CPHT certification alongside a High School Diploma or GED is required for this position, which operates within a high-paced dedicated program.

Qualifications

• Minimum three years’ experience in a customer service position with high volume call center experience.
• Preferably in healthcare, social services, or a similar service position.
• Certification required for prior authorization role.

Responsibilities

• Assist with outbound calls and monitor/respond to inquiries.
• Handle inbound calls/fax requests with professionalism.
• Process information accurately as per requirements.
• Maintain documentation of approvals and denials.
• Analyze clinical algorithms and provide decisions on PA Requests.
• Deliver quality customer service to healthcare providers.

Skills

Customer service

High volume call handling

Confidentiality

Professional communication

Education

High School Diploma or GED

Three years customer service experience

CPHT certification

Job description

• The Tech I will also assist with other duties such as outbound calls, monitoring / responding to inquiries in mailboxes and other duties as assigned by the leadership team.
• Effectively manage work volume by handling inbound calls / fax requests utilizing appropriate courteous and professional behaviour based upon established standards.
• Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
• This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process.
• Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist.

Duties:

• Analyse clinical algorithms and provide decisions regarding PA Requests.
• Use of online databases and other resources to document appropriate recommendations, clinical decisions and responses.
• Provide ongoing education on the PA Program to healthcare providers and internal partners.
• Deliver the highest quality customer service to healthcare providers and internal providers in a high paced dedicated PA program.
• Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers).
• Ability to maintain confidentiality.

Shift Times:

• 8.00 AM TO 4.30 PM

Training Information:

• Training During Day from 9/29 - 10/10 (Monday - Friday)
• Shift: 6:00AM - 2:30PM

Qualifications

Experience / Education:

• Minimum three years’ experience required in a customer service position with high volume call centre experience
• Preferably in healthcare, social services, or a similar service position.
• Prior Authorization requires a cpht for the role along with a High School Diploma or GED.

Additional Information

All your information will be kept confidential according to EEO guidelines.