Prior Authorization Representative II

Job Summary

Working remotely full-time, the Prior Authorization Representative II will manage insurance verification, obtain benefit information, and secure prior authorizations before services are rendered, collaborating with healthcare providers to resolve authorization issues.

Key responsibilities

• Contact insurance companies for patient eligibility, benefits, and authorization
• Follow up on delayed or denied authorization requests and facilitate medical determinations
• Maintain accurate documentation of authorization history and ensure correct coding submissions

Required qualifications

• Three years of experience in a healthcare financial setting, or equivalent experience
• Six months of experience as a Prior Authorization Representative I or equivalent
• Familiarity with insurance and prior authorization processes
• Knowledge of ICD and CPT coding
• Experience with inpatient and day surgery prior authorizations is preferred