Prior Authorization Representative

Job Summary

To support a busy rheumatology clinic, the full-time Prior Authorization Representative will coordinate prior authorization and referral processes for patients, engaging with providers and patients to ensure seamless care while working in a remote/hybrid environment.

Key responsibilities

• Manage the prior authorization and referral processes, including confirming patient health plan coverage and obtaining necessary documentation
• Facilitate scheduling for patients with various departments and ensure accurate updates in the system regarding authorizations and referrals
• Communicate effectively with providers, care teams, and patients regarding insurance benefits, eligibility, and the authorization process

Required qualifications

• High School diploma or GED
• Minimum of one year experience in a hospital, clinic, or medical insurance billing office related to medical billing or pre-authorization
• Basic understanding of medical coding
• Strong organizational skills and ability to prioritize workflows
• Intermediate experience with electronic medical records systems and MS Office applications