Customer Service Representative II

2 weeks ago


Selma, Alabama, United States TAJ Technologies Inc Full time
Job Description

The Prior Authorization Representative plays a crucial role in ensuring patient access to various therapies by verifying prior authorization requirements and obtaining authorization when necessary. This position works closely with physician offices and payers to facilitate patient access and ensures patient insurance coverage and benefits.

Key Responsibilities:
  • Validate patient insurance coverage and communicate any issues with benefits or coverage to the appropriate managers.
  • Check the requirements for prior authorization and initiate the process as required.
  • Coordinate required paperwork, clinical notes, and forms for submission to support requests and initiate the process as required.
  • Follow up frequently to ensure visibility on authorization status throughout the approval process.
  • Have basic knowledge of payer payment processes and detailed knowledge of the payer prior authorization process.
  • Have basic ICD9/10 and CPT code familiarity, as well as expert knowledge on a subset of Medtronic therapy codes.
  • Provide superior customer service skills with outstanding communication skills to use with various stakeholders, including physicians, sales representatives, payer representatives, utilization reviewers, and internal and external stakeholders.
  • Have advanced Microsoft Excel skills and the ability to learn and use multiple CRM software programs as needed.
  • Have good organizational skills with the ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail.

Requirements:

  • Basic knowledge of payer payment processes.
  • Detailed knowledge of the payer prior authorization process.
  • Basic ICD9/10 and CPT code familiarity.
  • Expert knowledge on a subset of Medtronic therapy codes.
  • Superior customer service skills.
  • Outstanding communication skills.
  • Advanced Microsoft Excel skills.
  • Ability to learn and use multiple CRM software programs.
  • Good organizational skills.
  • Critical problem-solving skills.


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