Prior Authorization Submitter

About the role

The Prior Authorization Submitter (PAS) is responsible for managing insurance requests for medical necessity and prior authorization of durable medical equipment. This involves creating and submitting submission packets via online portals, faxes, and mail, then following up on payer decisions. They ensure all steps are documented accurately in electronic records and collaborate with insurance companies to facilitate authorization processes.

Responsibilities

• Review funded cases and verify completeness of required information
• Prepare and submit prior authorization requests per payor specifications
• Maintain detailed records of submissions and communications
• Follow up with payors regarding request status
• Identify trends in payor responses and assist with intake functions as needed
• Perform additional tasks to support team goals

Qualifications & Skills

• High school diploma or relevant medical office experience with knowledge of diagnosis codes and insurance processes, or prior authorization experience
• Strong communication skills, especially with department managers and directors
• Proficiency in MS Office (Word, Outlook) and ability to handle multiple online applications
• Familiarity with PDFs and coordination of benefits for Medicare, Medicaid, and third-party insurers
• Detail-oriented with excellent organizational skills
• Ability to spend significant time on outbound calls and work in a fast-paced environment

Work Environment

The role requires prolonged desk work, adaptability to interruptions, and occasional travel to the office for team activities or training.