Job Description

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 Include, But Are Not Limited To

Validates insurance patient’s 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 Medtronic 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 problem-solving skills with high attention to detail