What are the responsibilities and job description for the Customer Service Representative II position at TAJ Technologies Inc?
Prior Authorization Representative Role
The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. This role involves working directly with physician offices and payers to facilitate patient access to various therapies. The representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Additionally, they will assist with appealing prior authorization denials, retro authorization, or other special cases.
Responsibilities Include:
Validates insurance patient's coverage and communicates any issues with benefits or coverage to the appropriate managers
Checks the requirements for prior authorization and initiates as required
Coordinates required paperwork, clinical notes, and forms for submission to support requests and initiates as required
Follows up frequently to ensure visibility on authorization status throughout the approval process
Possesses basic knowledge of payer payment processes and detailed knowledge of the payer prior authorization process
Has basic ICD9/10 and CPT code familiarity, with expert knowledge on a subset of Medtronic therapy codes
Demonstrates superior customer service skills with outstanding communication skills to use with various stakeholders, including physicians, sales representatives, payer representatives, utilization reviewers, and internal and external stakeholders
Possesses advanced Microsoft Excel skills and the ability to learn and use multiple CRM software programs as needed
Exhibits good organizational skills with the ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail
The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. This role involves working directly with physician offices and payers to facilitate patient access to various therapies. The representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Additionally, they will assist with appealing prior authorization denials, retro authorization, or other special cases.
Responsibilities Include:
Validates insurance patient's coverage and communicates any issues with benefits or coverage to the appropriate managers
Checks the requirements for prior authorization and initiates as required
Coordinates required paperwork, clinical notes, and forms for submission to support requests and initiates as required
Follows up frequently to ensure visibility on authorization status throughout the approval process
Possesses basic knowledge of payer payment processes and detailed knowledge of the payer prior authorization process
Has basic ICD9/10 and CPT code familiarity, with expert knowledge on a subset of Medtronic therapy codes
Demonstrates superior customer service skills with outstanding communication skills to use with various stakeholders, including physicians, sales representatives, payer representatives, utilization reviewers, and internal and external stakeholders
Possesses advanced Microsoft Excel skills and the ability to learn and use multiple CRM software programs as needed
Exhibits good organizational skills with the ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail
