Job Details

Remote Prior Authorization Representative

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The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. The representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Assists with appealing prior authorization denials, retro authorization, or other special cases.

Responsibilities Include, But Are Not Limited To:

• Validate insurance coverage and communicate issues with benefits or coverage to the appropriate managers.
• Check requirements for prior authorization and initiate as required.
• 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.

Requirements:

• Basic knowledge of payer payment processes with detailed understanding of the payer prior authorization process.
• Familiarity with ICD9/10 and CPT codes; expert knowledge on a subset of company therapy codes.
• Superior customer service skills and outstanding communication skills to interact with physicians, sales representatives, payer representatives, utilization reviewers, and other stakeholders.
• Advanced Microsoft Excel skills and ability to learn and use multiple CRM software programs.
• Good organizational skills with the ability to handle multiple inquiries simultaneously and critical problem-solving skills with high attention to detail.

The Planet Group of Companies is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.