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Pre Authorization Specialist

Marlborough, MA

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  • Answers incoming calls received through the toll free Pre-Authorization Support ACD and provide appropriate call/case handling.
  • Performs initial benefit verification and pre-surgical authorization for new pre-surgical cases by working closely with all payers
  • Documents case status, actions, and outcome in the Pre-Authorization Support contact management database.
  • Communicates and builds relationships with HCP offices and sales representatives
  • Responsible for notifying the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/ adverse event notifications 


Job Requirements

  • High School diploma or Equivalent
  • College preferred/College undergraduate degree strongly preferred. 
  • 1+ year's experience in Insurance Reimbursement or Medical device industry is require
  • Must be able to understand the complexities of the Insurance Reimbursement work flow and related processes. 
  • Basic understanding of Medicare, Medicaid, Private Payer, and Workers compensation coding, coverage, and payment as it relates to medical procedures, services, and devices
  • Strong computer skills and have working knowledge of Microsoft outlook, Microsoft Word and Excel.
  • Type minimum of 45 wpm
  • Must have exceptional organizational skills and a keen attention to detail, and be multi-task oriented 
  • Must pass assessments before interview is granted. 
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