Prior Authorization Representative at DME Service… · Location…

Prior Authorization Representative

Job Duties and Responsibilities:

• Verify the patient’s medical and pharmacy coverage/benefits to confirm authorization requirements via system and/or insurance portals.
• Validating Authorization requirement on Durable Medical Equipment (DME) for Diabetic Supplies, Urological and Catheter products, Incontinence supplies, thickeners, and nutritional supplements, Breast pumps and other healthcare related products for 150+ insurances/Payers.
• Submit Authorization request to appropriate Insurance based on patient’s coverage whether through call, portal, or fax accurately.
• Validates the status of Authorization request through call, portal, or fax accurately.
• Initiate outbound calls to Insurances to validate benefit information and request Authorization, check for status, follow-up, and/or re-initiate authorization as necessary.
• Manages an average of 1000+ patient accounts per month.
• Maintains accurate and detailed records in company database.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback to improve processes and policies.
• Attends all department, team, and weekly company meetings as required.
• Perform any additional responsibilities or special projects as required.
• Duties and responsibilities may be subject to change based upon the needs of the department.

Job Required Qualification:

• Minimum 3-year solid experience with US Healthcare Insurance
• At least 1 year work experience in a customer service call center (Voice and Back office)
• Experience with medical Insurance/Benefits investigation and Authorizations is highly preferred.
• Excellent Customer service skills, including phone and interpersonal skills.
• Computer proficiency in MS Word, Excel, and Outlook preferred
• Typing accuracy of 35 wpm minimum
• Database data entry experience preferred.
• Strong knowledge and use of the English language, both written and verbal
• Work history of excellent attendance and punctuality
• High comfort level working with culturally diverse team members and clients.
• Proficient mathematical skills, including addition, subtraction, multiplication, and division.

Preferred Qualifications:

• Startup / rapid growth experience
• Life sciences, pharmaceutical, or medical device experience.
• Knowledge of medical terminology preferred.
• Knowledge diabetes

Language Skills

Must be able to communicate effectively in English. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.