Prior Authorization Intake Representative Jobs

Assists management in developing training materials.

Maintains a working knowledge of computer systems supported by the department.

Strong oral and written communication skills

Expedites sorting of surgical cases and checks status of prior authorization with shortest lead times.

Documents prior authorization activities appropriately and communicates necessary information to SCORE Prior Authorization team.

Evaluates processes, problem solving, and participates in departmental continuous improvement programs to enhance workflow processes and patient-centered outcomes.

TITLE: Prior Authorizations and Referral Management Representative

Intermediate proficiency in Microsoft applications (Word, Excel, Project, PowerPoint, and Access), SharePoint, database management, and document preparation.

REPORTS TO POSITION: Clinic Manager

Confirms patient participation in health plan and obtains accurate benefit coverage.

Effectively communicate with provider, care team members and patients regarding authorizations, scheduling needs, insurance benefits etc.

Assist with patient education and follow up regarding the prior authorization and referral processes.

Required Additional Knowledge, Skills and Abilities:

Preferred Additional Knowledge, Skills and Abilities:

(Will consider three years related post high school education/experience)

High School education or equivalent

If any experience is required, please specify what kind of experience:

If yes, what is the required licensure/certification?

∙ Bachelor’s degree in related field or equivalent work experience preferred

Medicare Part D CMS Regulations.

Proficient in navigation of multiple computer applications

∙ Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors

∙ Ability to type more than 30 WPM

∙ Six months of PBM/pharmaceutical related work strongly desired

Good communication skills are essential, both internal and external. Knowledge of Medicare benefits, enrollments, and LIS assistance.

Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations, and appeals processing.

At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service

Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

• Bachelor’s degree in related field or equivalent work experience preferred

Ability to work in a fast-paced environment, handling both inbound and outbound calls.

Provide refill management calls and follow up to Specialty Pharmacy patients when assigned.

Completion of a Bachelor’s degree or equivalent combination of education and experience.

Knowledge of healthcare billing, experience working with insurance and/or federal and state assistance programs is desirable.

Assist patients and staff with benefits investigation and enrollment of patients into pharmacy services (i.e. specialty pharmacy).

Provide the highest customer service experience for patients and providers.

Identify areas to improve the benefits investigation and prior authorization process.

Previous experience in pharmacy or healthcare industry

1+ years' experience in customer service or call center environments.

This position could require mandatory overtime.

Preferred Experience, Skills, and Capabilities

Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post-service requests.

Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

Checks benefits for facility-based treatment.

At least 1 year of work experience in Prior Authorizations is preferred

Specialty Pharmacy or Pharmacy experience is preferred

Preferred Skills, Capabilities, and Experiences:

Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

Knowledgeable in reading Rx's, Processing claims and submit Prior Authorizations via CMM, fax and verbally

Date Posted: May 19, 2023

Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers.

Review prescription for accuracy of prescribed treatment regimen prior to submission of authorization.

Ability to multitask, be detail oriented, organized, and exercise good time management skills

Other duties and responsibilities as assigned

Minimum 1 year work experience required, 1 year customer service experience preferred

Excellent communication skills, both written and verbal, with a pleasant and professional communication style

Strong interpersonal skills and customer service focus

Must possess basic contract knowledge and have the ability to interpret and communicate various provisions

Knowledge of third party payers.

Skill and proficiency in oral and written communication including spelling, grammar, punctuation, and composition.

Offers assistance to patients, patient’s families, customers, physicians, Home Health/Hospice agencies, and other referral sources.

One year of administrative, customer service, or healthcare experience, preferably from a home health environment.

Proven record of providing excellent customer service both internally and externally.

Ability to set priorities, coordinates multiple tasks, maintains work flow, and prepares written materials.

Understand and execute the principles of Prior Authorization to facilitate the right care at the right time in the right setting.

Able to solve complex prior authorization questions and issues.

Prioritizes and processed incoming insurance verifications and prior authorization requests.

Preferred - Associate’s Degree in Business, Finance, Health Information Management, or a related field.

Minimum – One (1) year of experience in healthcare, business, finance, or insurance related field.

Demonstrate skilled communication and troubleshooting techniques as well as excellent customer service skills.

UW Hospital and Clinics benefits

Obtain prior authorization from payers for inpatient and outpatient services provided by UW Health.

Anticipate and respond to a wide variety of issues/concerns and the ability to execute tasks efficiently and effectively.

Previous experience verifying detailed insurance benefits and authorization requirements preferred.

Verifying correct patient information, including insurance benefits and authorization requirements for permanent and transient patients.

Must have intermediate computer skills, including Microsoft Office (Word, Excel, Outlook); Working knowledge of Internet for business use.

Requires research and exceptional organization skills to manage a large patient load.

Keep up to date on COB rules according to insurance guidelines and requirements.

Knowledge of various health insurance programs and the medical insurance industry preferred.

11. Hours are Monday - Friday 8am-5pm Fully remote!

2. Interprets department policies, reimbursement and coverage guidelines for referral sources and general public.

3. Appropriately communicates information according to department policies and procedures.

4. Contributes to program effectiveness.

5. Organizes and performs work effectively and efficiently.

6. Maintains and adjusts schedule to enhance department performance.

What you’ll love about working here:

We are not able to hire residents of the following states:

For positions that are Flex/WAH:

Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

Checks benefits for facility based treatment.

Medical terminology training and experience in medical or insurance field preferred.

Previous experience in call center environment.

Responsible for coordinating cases for precertification and prior authorization review.

Date Posted: Mar 29, 2023