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Pre-Authorization Representative - Valencia, CA

Valencia, CA

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Description

Pre-Authorization Specialist - This role will be responsible for performing the initial benefit verification and pre-authorization functions with insurance carriers, within an established time frame, for new pre-surgical cases submitted to the Reimbursement Services Department. The Pre-Authorization Specialist is responsible for providing competitive levels of support to the internal team, Health Care Professional offices, and sales representatives. They are also responsible for answering incoming calls received through the Reimbursement Services Department ACD line. Key Responsibilities: • Answers incoming calls received through the toll free Reimbursement Services 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 Reimbursement Services contact management database • Communicates with HCP offices and sales representatives in regards to missing case information and upon approvals, as appropriate • Works closely with the designated Reimbursement Specialists as it relates to benefit verification information received, questions about pre-authorization, payer issues, and case volume • 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 • Utilizes customer service skills in engaging with customers, communications with Sales representatives, and working in teams in a call center environment to expedite processing of cases • Responsible for working with Reimbursement Services Manager to develop and generate key reporting metrics and for making Intake process improvement recommendations Quality Systems Duties and Responsibilities: Build Quality into all aspects of their work by maintaining compliance to all quality requirements.

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