Prior Authorization Representative

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

• 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
• Covers 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
• Follows payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of *** 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

Qualifications

• Bachelor's degree in a relevant discipline preferred
• High School Diploma required
• 3+ years of relevant experience
• Basic ICD9/10 and CPT code familiarity
• Basic knowledge of payer payment process with detailed knowledge on the payer prior authorization process
• 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

Pay & Schedule

Pay: $22.00/hr; W2 contract, no PTO, no Benefits. ACA-compliant supplemental package available for enrollment.

Benefits

N/A

Schedule

100% remote position

Primary Talent Partners is an Equal Opportunity / Affirmative Action employer committed to diversity in the workplace.