Full Time - Prior Authorization Representative

Clinpath Diagnostics•Phoenix, AZ

1d•Onsite

About The Position

This position will complete training at our North Phoenix office located at 1929 W. Lone Cactus Dr., Phoenix, AZ 85027. Upon successful completion of training, the role will be based at our laboratory located at 4313 E. Cotton Center Blvd., Phoenix, AZ 85040. Hours: Monday-Friday 7:00am - 3:30pm or 8:00am-4:30pm As a Prior Authorization Representative, you would work in a fast-paced environment managing pathology patient accounts. Core responsibilities include reviewing laboratory testing orders, gathering and verifying necessary documentation, submitting prior authorization requests to insurance companies, monitoring the status of those requests, and communicating updates or additional requirements to providers and leadership in a timely manner. Employees are responsible for following all Company policies and procedures. These policies and procedures will include adherence to regulatory standards such as CAP, HIPAA, CLIA and OSHA, including safety standards in performing all aspects of the functions below.

Requirements

Minimum of 2 years experience in the healthcare field is required
Minimum 1 year experience in referrals/authorizations, eligibility, or registration.
Strong customer service and organizational skills are required.
Basic Microsoft Word, Excel, and PowerPoint skills required.
Demonstrate working knowledge of verifying patient insurance coverage (eligibility verification) and obtaining necessary approvals for treatment (prior authorization) under Medicare, Medicaid, and commercial insurance plans.
Ability to work both independently and in a team setting

Responsibilities

Review incoming laboratory test orders to determine prior authorization requirements.
Verify patient demographic information and insurance eligibility for all incoming test orders. Confirm and update necessary information to ensure proper processing of authorization requests and claims.
Ensure medical payor policy requirements are met and share feedback with managers and physicians as needed.
Track and document authorization progress in workflow software. Record authorization numbers for billing.
Communicate effectively with physicians, patients, and team members. Build meaningful relationships with internal and external teams.
Identify opportunities for workflow improvement. Provide ongoing feedback to ensure timely submission and resolution of authorization requests.
Compile trends and stay up to date on relevant changes to payor authorization guidelines.
Strictly adhere to confidentiality and HIPAA guidelines. Attend department meetings as required.