Prior Authorization Representative

Job Summary

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

Key responsibilities

• Engage with providers, care teams, and patients to manage prior authorization workflows effectively
• Confirm patient health plan coverage and communicate necessary information to health plans for authorization and referral processes
• Track and update patient orders and referrals, ensuring accurate scheduling and documentation throughout the process

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
• Experience with electronic medical records systems and MS Office applications
• Ability to perform basic to intermediate math calculations