Customer Service Rep II

Job Title: Customer Service Representative II (Prior Authorization Representative)

Location: Remote – Virtual Connecticut 06355

Duration: 24 Months

Pay Rate: $24 – $25/hour

Job Summary:

This role is responsible for managing prior authorization processes to ensure patients can access required therapies. It involves verifying insurance coverage, submitting authorization requests, and communicating with physician offices and payers. The representative also handles appeals and special authorization cases.

Key Responsibilities:

Verify insurance coverage and communicate benefit issues to management.

Determine and initiate required prior authorizations.

Gather and submit clinical documentation to support authorization requests.

Track and follow up on authorization status.

Support appeals, retro authorizations, and special case handling.

Required Skills & Knowledge:

Strong knowledge of payer prior authorization processes.

Familiarity with ICD-9/10 and CPT codes.

Excellent communication and customer service skills to engage with various stakeholders.

Advanced Microsoft Excel proficiency.

Experience using CRM software.

Strong organizational and multitasking abilities.

High attention to detail and problem-solving capabilities.