Prior Authorization Representative

Prior Authorization Representative

Remote: Although this position is listed as remote, the training period requires you working onsite 5 days/week for 3 months at our Middleburg Heights, Ohio facility before transitioning to remote. Due to business requirements, only applicants residing in Ohio will be considered.

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 Microsoft Excel and Word

• Ability to multitask, establish priorities, and work independently

• Salary Range: $19-$22 per hour

Qualifications

Skills

• Behaviors

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• Motivations

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Education

Experience

• Licenses & Certifications

• Equal Opportunity Employer

• This employer is required to notify all applicants of their rights pursuant to federal employment laws.

• For further information, please review the Know Your Rights notice from the Department of Labor.

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