Customer Service Representative II Prior Authorization

Job Title: Customer Service Representative II – Prior Authorization

Location: Virtual, Georgia 30339

Duration: 24 Months

Role

Handle insurance verification, benefits, prior authorizations, and patient access for therapies. Work with physician offices, payers, utilization reviewers, sales, and internal teams.

Key Responsibilities

• Verify insurance coverage and benefits and identify prior authorization requirements.
• Initiate and submit prior authorization requests, including clinical notes, forms and supporting documentation.
• Track authorization status and follow up through approval.
• Assist with denials, appeals, retro-authorizations and special cases.
• Communicate with physician offices, payers, utilization reviewers and internal stakeholders.
• Apply knowledge of payer processes, ICD-9/10 and CPT codes.
• Manage multiple inquiries with strong organization, problem-solving and attention to detail.
• Use Excel and CRM systems for tracking and case management.
  
  

Must-Have

• Experience with Prior Authorization, Insurance Verification, Benefits Verification or Patient Access.
• Knowledge of healthcare payer processes and prior authorization workflows.
• Familiarity with ICD-9/10 and CPT codes.
• Strong customer service and communication skills.
• Advanced Excel skills and ability to learn multiple CRM systems.
• Strong organization, multitasking, problem-solving and attention to detail.