Customer Service Rep II - Non-Exempt Job Auburn area,Alabama USA,Healthcare

The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. The Representative will ensure patient insurance coverage and benefits, identify requirements for prior approval, and submit for authorization. Assists with appealing prior authorization denials, retro authorization, or other special cases.

Responsibilities Include, But Are Not Limited To:

Validates insurance patient’s coverage, communicates any issues with benefits or coverage to the appropriate managers.

Checks the requirements for prior authorization and initiates as required.

Coordinates required paperwork, clinical notes, and forms for submission to support requests and initiates as required.

Follows up frequently to ensure visibility on authorization status throughout the approval process.

Basic knowledge of payer payment process with detailed knowledge on the payer prior authorization process.

Basic ICD9/10 and CPT code familiarity, expert knowledge on a subset of Medtronic therapy codes.

Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders.

Advanced Microsoft Excel skills. Ability to learn and use multiple CRM software programs as needed.

Good organizational skills with the ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail.

“TAJ Technologies, Inc. is an EEO/AA

Employer:

women, minorities, the disabled and veterans are encouraged to apply.”

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