Prior Authorization Representative

Key Responsibilities: Review case and insurance coverage information to customize the content of the call to the insurance company or physician's office. Provide insurance company representatives with an overview of the services in which coverage is being requested in the attempt to obtain prior authorization. Answer questions regarding the reimbursement process and direct testing specific and treatment questions. Complete SMN (statement of medical necessity) form based on client or insurance requirements and fax to the ordering physician's office for completion. Follow up contact may be needed with the insurance company or physician's office based on pending documentation or approval. Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task. Participate in team meetings by sharing the details of cases worked. Other duties as assigned. Education/Experience:

High School diploma or GED Minimum of two years customer service experience Knowledge of the health insurance terminology and billing process or equivalent Proficient and attentive to details Possess superior customer service skills Possess excellent writing and verbal communication skills Ability to maintain confidentiality Proficient in using Microsoft Excel and Word Ability to multitask, establish priorities, and work independently