Customer Service Rep II

Overview

The Prior Authorization Representative is responsible for verifying priorauthorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access tovarious therapies. Representative will ensure patient insurance coverage and benefits, identify requirements for prior approval and submit forauthorization. Assists with appealing prior authorization denials, retroauthorization or other special cases

• Validates insurance patient’s coverage, communicate anyissues with benefits or coverage to the appropriate managers
• Checks the requirements for prior authorization and initiates as required
• Coordinates required paperwork, clinical notes and forms for submission to support request and initiates as required
• Follows up frequently to ensure visibility on authorizationstatus throughout the approval process
• Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity, expert knowledge onsubset of Medtronic therapy codes
• Superior customer service skills with outstandingcommunication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders,
• Advanced Microsoft Excel skills. Ability to learn and usemultiple CRM software programs as needed
• Good organizational skills with ability to handle multipleinquiries at the same time and critical problem-solving skills with high attention to detail

• Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of Medtronic therapy codes
• Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders
• Advanced Microsoft Excel skills. Ability to learn and use multiple CRM software programs as needed
• Good organizational skills with ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail

"TAJ Technologies, Inc. is an EEO/AA

Employer:

women, minorities, the disabled and veterans are encouraged to apply"