Prior Authorization Representative
Remote · Middleburg Heights, Ohio, United States
Job Summary
Review cases and insurance coverage to customize prior authorization requests; navigate payer portals to initiate/obtain status; provide overview of services submitted for prior authorization; answer questions on reimbursement and testing/treatment specifics; complete letters of medical necessity (LOMN) and coordinate with ordering physician; follow up with insurers/physicians; meet productivity and quality KPI goals; participate in team meetings and comply with SOPs; perform other duties as assigned.
Required Qualifications
- High School diploma or GED
- Previous health insurance billing experience
- Working knowledge of medical terminology
- Proficient and attentive to details
- Excellent written and verbal communication skills
- High attention to detail
- Ability to maintain confidentiality
- Proficient in using Microsoft Excel and Word
- Ability to multitask, establish priorities, and work independently
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