Prior Authorization Representative

Quadax, Inc.•Middleburg Heights, OH

10d

About The Position

This role involves reviewing case and insurance coverage information to customize prior authorization requests, navigating payer portals to check authorization status, and communicating with insurance company representatives. The representative will also complete and send out Letters of Medical Necessity (LOMN) to physicians' offices, follow up as needed, and ensure timely completion of assigned tasks to meet benefit investigation process standards. Additionally, the role requires participation in team meetings, adherence to SOPs, meeting productivity and quality goals, and performing other assigned duties.

Requirements

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

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.