Prior Authorization Representative

• Confirm, enter, and/or update required demographic data on patients and guarantors
• Verify patient insurance eligibility, benefits, and authorization
• Secure prior authorization and manage authorization-related denials
• Follow up on appeals and denials when requested
• Contact patients or providers when authorization is unsecured before the scheduled date of service
• Escalate issues that cannot be resolved independently
• Maintain departmental and individual work queues
• Review work for self-quality and due diligence
• Meet or exceed departmental productivity, due diligence, and quality standards

• Demonstrated experience in a healthcare revenue cycle role utilizing authorization tools
• Basic understanding of medical terminology
• Demonstrated experience in a customer service role
• Demonstrated experience in a role requiring strong attention to detail and accuracy
• Basic understanding of healthcare billing and coding procedures
• High School Diploma or Equivalent from an accredited institution (preferred)
• Two years of healthcare revenue cycle experience (preferred)
• Two years of experience in a customer-service related role (preferred)
• EPIC experience (preferred)
• Ability to work Monday–Friday, 8:00am–4:30pm
• Ability to perform required computer, phone, communication, visual, and manual-dexterity tasks

Demonstrates expertise in healthcare revenue cycle management, including patient authorization processes and insurance verification. Strong attention to detail and accuracy in handling demographic data and appeals management is essential.

• Healthcare Revenue Cycle Experience
• Authorization Tools Proficiency
• Medical Terminology Knowledge
• Customer Service Experience
• EPIC Experience

• Patient Insurance Verification
• Prior Authorization Management
• Healthcare Billing Procedures
• Healthcare Coding Procedures
• Data Entry Accuracy

• Attention to Detail
• Problem-Solving
• Communication Skills

• High School Diploma or Equivalent

• Healthcare
• Revenue Cycle
• Demographic Data
• Authorization Denials
• Appeals Management

• EPIC