Prior Authorization Representative

Key Responsibilities:

• Review case and insurance coverage information to customize the content of the call to the insurance company or physician’s office.
• Provide insurance company representatives with an overview of the services in which coverage is being requested in the attempt to obtain prior authorization.
• Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
• Complete SMN (statement of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.
• Follow up contact may be needed with the insurance company or physician’s office based on pending documentation or approval.
• Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.
• Participate in team meetings by sharing the details of cases worked.
• Other duties as assigned.

Education/Experience:

• High School diploma or GED
• Minimum of two years customer service experience
• Knowledge of the health insurance terminology and billing process or equivalent
• Proficient and attentive to details
• Possess superior customer service skills
• Possess excellent writing and verbal communication skills
• Ability to maintain confidentiality
• Proficient in using Microsoft Excel and Word
• Ability to multitask, establish priorities, and work independently