Prior Authorization Representative I

The Prior Authorization Representative I is responsible for securing outpatient accounts by performing insurance verification, obtaining benefit information, calculating patient estimates, and obtaining prior authorization before services are rendered. This position works with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process. The role involves verifying insurance eligibility, benefits, network status, and creating pre-service liability estimate, while ensuring accurate ICD, CPT codes and related medical records are submitted in the authorization request. The role is also focused on following up on delayed or denied authorization requests and escalates for resolution, along with creating detailed documentation and maintaining/stores the authorization paper trail.