Prior Authorization Representative

Job Summary

To support patient care coordination, the part-time Prior Authorization Representative will manage prior authorization and referral processes, ensuring accurate communication between patients and healthcare providers while working in a hybrid remote environment.

Key responsibilities

• Coordinate prior authorization and referral processes for patients requiring services and testing
• Validate patient health plan coverage and communicate necessary information to health plans for financial clearance
• Facilitate scheduling and manage documentation related to prior authorizations and referrals across various departments

Required qualifications

• High School diploma or GED
• Minimum of one year of experience in a hospital, clinic, or medical insurance billing office
• Basic understanding of medical coding
• Intermediate experience with electronic medical records systems and MS Office applications
• Strong organizational and customer service skills