Prior Authorization Specialist
6 days ago
Job Summary
The Prior Authorization Representative is a key member of the Hire Talent team, responsible for ensuring seamless patient access to various therapies. This role requires strong communication and problem-solving skills to facilitate collaboration with physician offices and payers.
Responsibilities
- Validate patient insurance coverage and communicate any issues with benefits or coverage to the appropriate managers.
- Verify prior authorization requirements and obtain authorization when necessary.
- Coordinate required paperwork, clinical notes, and forms for submission to support requests.
- Follow up frequently to ensure visibility on authorization status throughout the approval process.
- Utilize knowledge of payer payment processes and prior authorization procedures to ensure efficient patient access.
- Develop and maintain strong relationships with physicians, sales representatives, payer representatives, and other stakeholders.
- Apply advanced Microsoft Excel skills to analyze data and optimize processes.
- Stay up-to-date on industry developments and regulatory changes to ensure compliance and best practices.
Requirements
- Basic knowledge of ICD9/10 and CPT codes, with expertise in a subset of client therapy codes.
- Superior customer service skills and outstanding communication abilities.
- Excellent organizational skills and ability to handle multiple inquiries simultaneously.
- Critical problem-solving skills with high attention to detail.
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