Prior Authorization Representative

Job Summary

Coordinating prior authorization and referral processes for patients, the full-time Prior Authorization Representative will engage with providers and patients to facilitate care, manage scheduling, and ensure accurate benefit eligibility in a hybrid work environment.

Key responsibilities

• Manage prior authorization and referral processes by confirming patient health plan coverage and communicating necessary information to health plans
• Coordinate scheduling for patients with internal and external departments, ensuring timely and accurate appointments and authorizations
• Track and update systems with current information regarding prior authorizations and referrals, maintaining oversight of patient work queues

Required qualifications

• High school diploma or GED required; college-level coursework preferred
• Minimum of one year of experience in a hospital, clinic, or medical insurance billing office related to medical billing or pre-authorization
• Basic understanding of medical coding
• Intermediate experience with electronic medical records systems and MS Office applications
• Ability to perform basic to intermediate math calculations