Job Title: Customer Service Representative II – Prior Authorization Location: Virtual, Georgia 30339 Duration: 24 Months
Role
Handle insurance verification, benefits, prior authorizations, and patient access for therapies. Work with physician offices, payers, utilization reviewers, sales, and internal teams.
Key Responsibilities
Verify insurance coverage and benefits and identify prior authorization requirements.
Initiate and submit prior authorization requests, including clinical notes, forms and supporting documentation.
Track authorization status and follow up through approval.
Assist with denials, appeals, retro-authorizations and special cases.
Communicate with physician offices, payers, utilization reviewers and internal stakeholders.
Apply knowledge of payer processes, ICD-9/10 and CPT codes.
Manage multiple inquiries with strong organization, problem-solving and attention to detail.
Use Excel and CRM systems for tracking and case management.
Must-Have
Experience with Prior Authorization, Insurance Verification, Benefits Verification or Patient Access.
Knowledge of healthcare payer processes and prior authorization workflows.
Familiarity with ICD-9/10 and CPT codes.
Strong customer service and communication skills.
Advanced Excel skills and ability to learn multiple CRM systems.
Strong organization, multitasking, problem-solving and attention to detail.