Pre-Authorization Rep

Job Summary: The Prior Authorization Representative is responsible for obtaining pre-certifications and pre-authorizations for procedures and medications. Previous experience in a clinic and hospital setting preferred.

Must have excellent verbal and written communication skills. Requires effective customer relation skills, ability to organize and interpret data. Requires good judgment, tact, diplomacy, and ability to problem solve. Able to work effectively in a team environment. Able to use a personal computer and related software.

Duties/Responsibilities:

• Contact insurance carriers to verify patients insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior authorizations prior to services being performed.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Communicate any insurance changes or trends among team.
• Maintains a level of productivity suitable for the department.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Setting up medication shipments
• Assist patient financially responsibility & set-up payment.
• Abides by all HIPAA and confidentiality regulations and policies.
• Other duties as assigned.

Required Skills/Abilities:

• Phressia, Allscripts PM, EHR
• Written Communication- Writes clearly and informatively; Able to read and interpret written information accurately.
• Knowledge of CPT, ICD-9, ICD-10, coding and medical terminology including diagnosis codes.

Education and Experience:

High School or GED

3/5 year Medical Experience a must

Physical Requirements:

While performing the duties of this job, the employee is regularly required to talk or hear. Job frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. This is a largely sedentary role; however, some filing may be required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary