Prior Authorization Representative

This organization operates within the healthcare sector, specializing in neurosurgery services. It addresses challenges related to patient access, insurance verification, and surgical authorization processes to ensure patients receive timely and coordinated care. The organization focuses on improving the patient experience by streamlining insurance approvals and supporting efficient communication between patients, providers, and payers.

About the role

The Prior Authorization Representative plays a key role in facilitating patient access to surgical services by managing insurance verification and authorization activities. This position ensures that procedures receive the necessary approvals, supports patients in understanding their financial responsibilities, and coordinates closely with providers and insurance carriers to maintain an efficient and patient-centered experience.

Responsibilities

• Confirm insurance eligibility and benefits for scheduled procedures.
• Obtain prior authorizations and pre-certifications from insurance carriers.
• Calculate patient financial responsibility, including deductibles, copayments, and coinsurance.
• Communicate authorization requirements, coverage limitations, and non-covered services with professionalism and empathy.
• Serve as a liaison between patients, providers, and insurance companies regarding referral and authorization status updates.
• Maintain accurate records of authorizations, billing activities, claims, and related documentation.
• Support daily reconciliation processes and ensure information is entered accurately into relevant systems.
• Follow organizational policies and payer requirements to maintain compliance.

Requirements

• High school diploma or equivalent, or 1 year of relevant work experience.
• Professional licensure or certification may substitute for education or experience when applicable.
• Minimum of 2 years of experience with surgical prior authorizations.
• Knowledge of insurance verification, pre-certification, and authorization processes.
• Familiarity with medical terminology and healthcare billing concepts.
• Strong communication and customer service skills.
• Ability to manage multiple tasks while maintaining attention to detail.
• Proficiency with computer systems and electronic health records.

Pay

Hourly pay range of $21.31 to $28.84, based on experience and qualifications.

Benefits

• Paid time off (PTO)
• Medical, dental, and vision insurance options
• Wellness programs
• Retirement plans with employer matching contributions
• Short-term and long-term disability coverage
• Employee Assistance Program (EAP)
• Parental leave and adoption assistance
• Tuition reimbursement
• Community engagement and volunteer opportunities