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 Microsoft Excel and Word


• Ability to multitask, establish priorities, and work independently