Prior Authorization Representative

Job Summary

Coordinating prior authorization and referral processes for patients, the full-time Prior Authorization Representative will manage scheduling, validate health plan coverage, and facilitate communication between patients and healthcare providers in a hybrid work environment.

Key responsibilities

• Engage with providers and patients to confirm health plan coverage and manage prior authorization requests
• Coordinate scheduling of patient appointments with internal and external departments, clinics, and hospitals
• Monitor and update systems regarding prior authorization and referral requests to ensure accurate information flow

Required qualifications

• High School diploma or GED
• Minimum of one year experience in a hospital, clinic, or medical insurance billing office
• Basic understanding of medical coding
• Proficiency in electronic medical records systems and MS Office applications
• Ability to perform basic to intermediate math calculations