Insurance Verification Specialist

Overview

The Prior Authorization Representative plays a crucial role in ensuring patients receive timely access to therapies by verifying insurance coverage and managing prior authorization processes. This contract position is remote and expected to last 12 months with potential extensions.

Key Responsibilities

• Confirm patients' insurance coverage and promptly report any benefit or coverage issues to managers.
• Determine prior authorization requirements and initiate requests when necessary.
• Prepare and submit all necessary documentation, including clinical notes and forms, to support authorizations.
• Regularly follow up to maintain clear visibility on the status of authorizations during the approval workflow.
• Assist with appealing denied prior authorizations, retroactive authorizations, or other complex cases.

Required Knowledge and Skills

• Fundamental understanding of payer payment procedures, with in-depth knowledge of the prior authorization process.
• Familiarity with ICD9/10 and CPT codes, especially expertise in a subset of Medtronic therapy codes.
• Excellent customer service and communication capabilities to interact effectively with physicians, sales teams, payer representatives, utilization reviewers, and other stakeholders.
• Advanced proficiency in Microsoft Excel and adaptability to learn various CRM software tools.
• Strong organizational skills to manage multiple simultaneous inquiries and incisive problem-solving ability with acute attention to detail.