Prior Authorization Representative

Job Summary

A company is looking for a Prior Authorization Representative to review and process Medicare authorization requests and claims.

Key Responsibilities

• Review Prior Authorization Requests (PARs) and ensure documentation accuracy
• Process pre-payment and post-payment claims in accordance with CMS guidelines
• Research and resolve issues related to suspended claims and claims processing

Required Qualifications

• High School diploma or GED
• 2 years' experience in research and information interpretation
• Basic proficiency with Microsoft Suite (Excel, Word, SharePoint, and Outlook)
• 2 years related work experience in Medicare, claims processing, or a medical background preferred
• Understanding of Medicare claims processing systems such as MCS and FISS preferred