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
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