Customer Service Rep II - Non-Exempt

JOB DESCRIPTION

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. 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, communicate 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 request and initiates as required

Follows up frequently to ensure visibility on authorization status ...