What are the responsibilities and job description for the Prior Authorization Representative position at Three Point Solutions?
Job Title :
Prior Authorization Representative / Customer Service Rep II
Client : Medical Device Manufacturing Company
Duration : 2 Years with Possible of Extension
Location : Virtual CT 06355
Shift : 1st shift
Job Description :
The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required.
Works directly with physician offices and payers to facilitate patient access to various therapies.
Representative will ensure patient insurance coverage and benefits identify requirements for prior approval and submit for authorization.
Assists with appealing prior authorization denials retro authorization or other special cases
Responsibilities :
Validates insurance patients coverage communicate 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 request and initiates as required.
Follows up frequently to ensure visibility on authorization status throughout the approval process.
Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process.
Basic ICD9 / 10 and CPT code familiarity expert knowledge on subset of Client therapy codes.
Superior customer service skills with outstanding communication skills to use with various stakeholders physicians sales representatives payer representatives utilization reviewers various internal and external stakeholders Advanced Microsoft Excel skills.
Ability to learn and use multiple CRM software programs as needed.
Good organizational skills with ability to handle multiple inquiries at the same time and critical problemsolving skills with high attention to detail
Key Skills
Data Entry,Deputy,Drafting,Hibernate,Administration Support,Activex
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