Pre Service Prior Authorization Representative

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Acquire and finalize insurance authorization requests.

• Confirm insurance benefits and authorization prerequisites.

• Validate patient insurance and accurately enter information into systems.

• Thoroughly document accounts to enhance reimbursement and reduce denials or penalties.

• Achieve monthly individual accuracy and productivity targets.

• Initiate authorization requests with payers for all service lines.

• Validate existing authorizations requested by providers.

• Complete authorizations for acute and outpatient visits using submission tools and online platforms.

• Provide authorization numbers and patient demographic data to staff, including billing personnel.

• Clarify referral processes to physicians and staff members.

• Maintain records of referral activities and authorizations.

• Refer cases for peer review when necessary.

• Address provider requests for tests, procedures, and specialty appointments.

• Obtain authorizations for both single and recurring visits, including the verification of demographics, codes, service dates, and clinical information.

• Keep updated on payer requirements and third-party authorization submission software.

• Operate independently from a remote setting and prioritize tasks to ensure timely patient care.

• Adhere to escalation protocols for accounts that do not meet authorization standards.

• Perform cross-coverage and other relevant authorization responsibilities as assigned.

⛳️ Requirements

• High school diploma or GED is required.

• At least three years of experience in healthcare insurance and/or authorizations.

• Business acumen and experience in the designated work area.

• Familiarity with insurance payers.

• Knowledge of ICD-10 coding.

• Strong problem-solving abilities.

• Proficient computer skills and capacity to navigate multiple systems.

• Advanced skills in common office, word processing, spreadsheet, and database software.

• Ability to handle multiple tasks concurrently with minimal supervision and work independently.

• Detail-oriented with a focus on high productivity and accuracy.

• Outstanding organizational, interpersonal, and communication skills.

• Associate’s degree in Business Management is preferred.

• CRCR and/or CHAA certification is preferred.

🏝️ Benefits

• Opportunities for further education.

• Career advancement and mentorship.

• Work-from-home options.

• Recognized as a Great Place To Work® certified employer.