What are the responsibilities and job description for the Prior Authorization Representative position at Quadax?
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
