Customer Service Representative

Job Description

• Check the Prior Authorization Request (PAR) status in the portal, if available, before initiating contact with the Insurance Prior Authorization (PAR) department.
• Open sales orders and thoroughly examine the case details.
• Check workflow notes to understand the specific follow-up requirements.
• Utilize the PAR Follow-up Note Template in the Workflow notes when calling the insurance to follow up on prior authorizations.
• Liaise with insurance representatives to obtain determination status.
• Engage with insurance representatives to obtain and confirm PAR status, ensuring accuracy and completeness of information.
• Confirm relevant codes and inquire about turnaround times (TAT).
• Retrieve pending authorization numbers or ascertain if additional paperwork is required.
• Request fax backs for determination letters.
• Conduct continuous follow-ups with insurance until the paperwork is received.
• Create floating tasks to notify Prior Authorization Specialists of determinations or feedback.
• Coordinate with Prior Authorization Specialists if unable to reach insurance after 1 or 2 attempts.
• Seek alternate contact numbers, as the listed numbers may not always be accurate.
• Be prepared to answer questions about the call, document details, and faxing specifics.
• Follow PAR Submitted, PAR Follow-up, and PAR Received note templates for accurate documentation in the workflow notes.
• Document the PAR status in the workflow by adhering to the PAR Submitted, PAR Follow-up, and PAR Received note templates in Workflow notes.
• Navigate and use workflow tools effectively to streamline and document the prior authorization process.