Prior Authorization Representative

Key Responsibilities

• Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.
• Navigate through payer portals to initiate/obtain prior authorization status.
• Provide insurance company representatives with an overview of the services being submitted for prior authorization.
• Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
• Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.
• Follow up with the insurance company or physician’s office as needed.
• 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.
• Comply with all applicable SOPs.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Education/Experience

• High School diploma or GED
• Previous health insurance billing experience
• Working knowledge of medical terminology
• Proficient and attentive to details
• Excellent written and verbal communication skills
• High attention to detail
• Ability to maintain confidentiality
• Proficient in using Microsoft Excel and Word
• Ability to multitask, establish priorities, and work independently

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