Customer Service Rep II at Three Point Solutions Inc

Job title : Customer Service Rep II

Client : Medical Device Manufacturing Company

Duration : 02 year contract

Location : Virtual, CA 95678(Remote)

Shift : 1^ST Shift

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
• Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity,

Expert Knowledge

• expert knowledge on subset of client 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