Prior Authorization Representative

Job Summary

To support patient care coordination, the full-time Prior Authorization Representative will manage prior authorization and referral processes, ensuring accurate communication with health plans and facilitating scheduling for services and procedures in a hybrid work environment.

Key responsibilities

• Coordinate prior authorization and referral processes for patients, ensuring timely communication with providers and health plans
• Confirm patient health plan coverage and eligibility, updating necessary systems with accurate information
• Facilitate scheduling of patient appointments with internal and external departments, ensuring comprehensive care coordination

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
• Intermediate ability in computer applications, particularly electronic medical records systems and MS Office
• Excellent organizational and customer service skills