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

• 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 Client therapy codes
• Superior customer service skills with outstanding communication skills t o use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders,
• Advanced MS 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

Job Requirements

Customer service skills