Job type full-time
Full job description
Overview: prior authorization representatives work on the benefit investigation team to assist in obtaining prior authorizations from insurance companies on behalf of the client and the patientPrior authorizations may require the primary or ordering physician to be involved which will require contact with the practice rather than the insurance companyIn addition, based on coverage policies, pre-determination medical requests may be needed to validate the medical necessity as deemed by the insuranceAccount assignments are handled through worklistsResponsibilities:
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.
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