Prior Authorization Representative

Key Responsibilities: • Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office. • Navigate through payer portals to initiate/obtain prior authorization status. • Provide insurance company representatives with an overview of the services being submitted for prior authorization. • Answer questions regarding the reimbursement process and direct testing specific and treatment questions. • Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.

• Follow up with the insurance company or physician’s office as needed. • 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. • Comply with all applicable SOPs. • Meet or exceed productivity and quality KPI goals. • Perform other duties as assigned. Education/

Experience: • High School diploma or GED • Previous health insurance billing experience • Working knowledge of medical terminology • Proficient and attentive to details • Excellent written and verbal communication skills • High attention to detail • Ability to maintain confidentiality • Proficient in using bolthires Excel and Word • Ability to multitask, establish priorities, and work independently Equal Opportunity Employer

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