Prior Authorization Rep II

Verifies insurance eligibility, benefits, network status to create pre-service price estimates for insured patients.

Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request. Requires critical thinking to determine what each individual payer requires to authorize the visit.

Secures prior authorization for high dollar and complex services, which may include day surgeries, planned inpatient admissions, and high-end ancillary services. Responsible for the financial security of billions of dollars of gross revenue annually.

Acts as a liaison between the payer, medical support staff, and providers in the event that additional medical records are required to authorize.

Follows up on delayed or denied authorization requests and escalates for resolution. Facilitates provider and insurance medical directors reviews for medical determination if the visit should be authorized.

Creates and maintains detailed documentation of the authorization/notification trail.

Drives critical dependent workflows such as for case managers/utilization review to ensure length of stay authorization is secured.

Ability to work on other tasks while on long hold times with payer for authorization for another patient.