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Remote Prior Authorization Representative

Masons Island, CT 06355

Posted: 04/04/2025 Employment Type: Contract Job Category: Professional Services Job Number: 618855 Is job remote?: Yes Country: United States

Job Description


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

Responsibilities Include, But Are Not Limited To
  • Validates insurance patient’s coverage, communicate any issues 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 authorization status throughout the approval process
Requirements:
  • Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
  • Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of company 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

The staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly and never provide banking information during the application process. Candidate safety is a top priority at Planet Pharma.

Planet Pharma is an equal opportunity employer. It is our practice not to discriminate against any employee or applicant based on any criteria, condition or basis protected by laws or regulations in the locations where we do business. All qualified applicants are encouraged to apply. We celebrate diversity and are committed to providing an environment of mutual respect. We believe that diversity, equity and inclusion enable us to better meet our mission and values while serving our clients across the globe. If you have a disability or handicap and would like us to accommodate you in any reasonable way, please inform your recruiter, or contact us, so that we can discuss the appropriate alternatives available.

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About Masons Island, CT

Ready to embark on an exciting career journey in beautiful Masons Island, Connecticut? This charming waterfront community nestled in New London County offers not only picturesque views but also unparalleled career growth opportunities. With a vibrant arts scene, including galleries like the Hygienic Art Gallery and theaters like the Eugene O'Neill Theater Center, Masons Island provides a unique blend of culture and charm. Indulge in the delicious local seafood cuisine, explore historic landmarks like the Palmer-Wells House, or enjoy outdoor adventures at Barn Island Wildlife Management Area. Join us in discovering the endless possibilities that await in Masons Island, CT! Explore our job listings today and take the first step towards your dream job in this enchanting region.

Although this hasn't been an issue at Planet Pharma, the staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly and never provide banking information during the application process. Candidate safety is a top priority at Planet Pharma.