Prior Authorization Representative

Quadax

Key Responsibilities:

Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician's office.
Navigate through payer portals to initiate/obtain prior authorization status.
Provide insurance company representatives with an overview of the services being submitted for prior authorization.
Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician's office for completion.
Follow up with the insurance company or physician's office as needed.
Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.
Participate in team meetings by sharing the details of cases worked.
Comply with all applicable SOPs.
Meet or exceed productivity and quality KPI goals.
Perform other duties as assigned.

Education/Experience:

High School diploma or GED
Previous health insurance billing experience
Working knowledge of medical terminology
Proficient and attentive to details
Excellent written and verbal communication skills
High attention to detail
Ability to maintain confidentiality
Proficient in using Microsoft Excel and Word
Ability to multitask, establish priorities, and work independently

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Apply

Vacancy posted 3 days ago

Similar jobs that could be interesting for youBased on the Prior Authorization Representative in Cleveland, OH vacancy

Sales & Data Entry Agent - Full/Part Time - Remote
Job Opportunity Job Conversion, LLC is looking for experienced and entry-level sales reps who also have strong data entry skills. Work your own hours, from home or any location, with a flexible schedule and variable hours. Requirements Quiet, private work area...
Suggested
Full time
Part time
Remote work
Work from home
Flexible hours
Jobconversion, LLC
Cleveland, OH
18 hours ago
Accounts Receivable Representative II
...Overview The Accounts Receivable Representative II plays a key role in supporting accurate and timely accounts receivable operations. This position performs financial, administrative, and clerical work in a fast-paced, high-volume environment while helping ensure quality...
Suggested
Work at office
Flexible hours
AmTrust Financial
Cleveland, OH
4 days ago
Count Room Representative (4:45AM Shift Start) - Part Time
Role Responsibilities : Counts, sorts and organizes all money, coupons, chips and paperwork from the drop boxes. Lifts and displays empty drop boxes to Surveillance personnel and/or fellow team members. Retrieves drop boxes from the storage area and appropriately...
Suggested
Part time
Work at office
Shift work
Weekend work
JACK Entertainment
Cleveland, OH
1 day ago
Security Representative
...Security Representative At the Rock & Roll Hall of Fame, we are dedicated to making a difference. We are an inclusive & welcoming museum that encourages creativity, embraces innovation, and creates a culture of belonging. We recognize that exceptional candidates...
Suggested
Permanent employment
Contract work
Part time
Summer work
Seasonal work
Work at office
Local area
Flexible hours
Shift work
Rotating shift
Afternoon shift
Rock & Roll Hall of Fame
Cleveland, OH
2 days ago
Brewery Representative
$48k - $63k
...Job Description We are currently hiring a full-time, Brewery Representative in Northeast Ohio .The territory will include Erie, Lorain, Medina, Wayne, Lake, Geauga & Ashtabula Counties. The ideal candidatewilllive in territory, preferably Lake County, Lorain County or...
Suggested
Full time
Currently hiring
Remote work
Weekend work
Afternoon shift
Boston Beer Company
Cleveland, OH
18 hours ago
Front Office Representative
...Front Office Representative At Elevare Branding, we believe that exceptional customer experiences begin with meaningful connections. As a company dedicated to helping businesses strengthen their presence and reputation, we foster a professional, collaborative, and...
Full time
Work at office
Alphabe Insight
Cleveland, OH
3 days ago
Benefits Representative
$65k - $80k
...Description Position at AMBA Insurance Benefits Representative (1099 Independent Contractor) Location: Ohio (statewide,... ...and Health insurance license or willingness to obtain one prior to onboarding Motivation to grow income through a performance...
Full time
For contractors
Local area
AMBA
Cleveland, OH
18 hours ago
BDC Representative
Job Opportunity At Tim Lally Chevrolet Here at Tim Lally Chevrolet, we believe our employees are our greatest asset. As such, we treat all employees with respect and appreciation for their contributions to the company. We believe not only in providing ongoing training,...
Local area
Tim Lally Chevrolet
Cleveland, OH
4 days ago
Benefits Representative
$70k - $90k
...Position at AMBA Insurance Benefits Representative (1099, Independent Contractor) Location: Ohio Compensation: Commission + Bonuses Schedule: Self-Managed, Full-Time Commitment About AMBA For over 65 years, AMBA has proudly served retired public servants...
Full time
For contractors
Local area
AMBA
Cleveland, OH
18 hours ago
Medical Sales Representative
$80k - $100k
...we encourage applicants to opt into texting during the application process. Position Overview and Key Responsibilities: Sales Representative is responsible for driving business growth and ensuring exceptional patient outcomes through effective relationship building, territory...
Rehab Medical
Brooklyn Heights, OH
18 hours ago
Quality Assurance Representative- 1st shift
$25.96 per hour
...Quality Assurance Representative This position oversees compliance to the policies, procedures, work instructions contained in the... ...thyssenkrupp ("TK") name, trademark, domain name, and logo without authorization. They are posing as employees, representatives, or agents of...
Hourly pay
Local area
Relocation
Visa sponsorship
Day shift
thyssenkrupp
Brookpark, OH
7 hours ago
Fan Experience Ambassador
The Rock & Roll Hall of Fame in Cleveland, Ohio, is looking for a Fan Engagement Specialist. This part-time role requires a passion for music and great customer service skills. You'll be engaging with guests, providing support during events, and helping create memorable...
Part time
Flexible hours
Afternoon shift
Rock & Roll Hall of Fame
Cleveland, OH
4 days ago
Pharmacy Technician Representative
$18.46 - $37.84 per hour
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Job Summary This position is responsible for providing assistance...
Work at office
Work from home
Flexible hours
Health Care Service Corporation
Brooklyn Heights, OH
3 days ago
Travel Membership Sales Ambassador
...A leading membership organization in Cleveland, OH, seeks a Sales and Service Representative to drive sales and deliver exceptional customer service. Responsibilities include engaging travelers, achieving sales goals, and adhering to security protocols. Candidates should...
Flexible hours
Clear
Cleveland, OH
4 days ago
Airport Sales & Service Ambassador
...A leading membership organization is seeking a CLEAR Sales and Service Representative to engage with travelers at Cleveland Hopkins International Airport. This role focuses on driving membership growth by providing exceptional customer service and converting interactions...
Fountain-Fort Carson School District 8
Cleveland, OH
3 days ago
Customer Care Agent - Relocate to Warroad, MN
$23 - $29 per hour
Job Overview: Are you energized by solving problems, building trust and relationships with customers? As a Customer Care Agent at Marvin, you’ll be the go-to expert for our dealers and customers seeking support. You’ll guide users through product questions, warranty concerns...
Hourly pay
Relocation
Relocation package
Marvin
Cleveland, OH
18 hours ago
Route Sales Representative
...combines the best ingredients, recipes, and people to produce consistently high-quality breads and rolls that you will be proud to represent. We invest in good ingredients and good people alike, so that at Aunt Millie's you'll have more than a job, you'll have a career...
Aunt Millie's Bakeries
Cleveland, OH
3 days ago
Territory Sales Representative
$50k - $100k
...Entry Level Sales Representative: Job Summary: Are you financially happy in your current role? Does your current position have opportunities... ...Professional demeanor and attire. ~ Must be legally authorized to work in the country of employment without sponsorship for...
Full time
H1b
Work at office
Local area
Relocation package
Weekend work
Afternoon shift
LeafHome
Beachwood, OH
2 days ago
Field Representative - Part Time
$13 - $18 per hour
...schedule that works with your busy life and has unlimited earnings potential? Then join RDSolutions growing and diverse Field Representative Team! We are seeking individuals to join our team who are self-motivated, detail oriented and most importantly dependable...
Part time
Work at office
Flexible hours
Shift work
RD SOLUTIONS INC
Cleveland, OH
3 days ago
3508 Sales Rep - US
$100k
LeafFilter Gutters and Gutter protection No cold calling- no sweepstake giveaway- real people confirming your leads. Are you tired of cold calling looking for new business? Tired of the constant follow up, pay cuts, or unqualified leads? Tired of 3-5 hour meetings...
Full time
For contractors
Weekend work
Day shift
Afternoon shift
LeafHome
Bedford, OH
4 days ago
LHWS Sales Rep
$150k
...advancement to management roles? Leaf Home Water Solutions, a division of Leaf Home is looking to grow our team of Outside Sales Representatives TODAY! Why Work with Leaf Home Water Solutions? Working with Leaf Home Water Solutions is more than just another job - it...
Weekly pay
Part time
Local area
Work from home
LeafHome
Bedford, OH
3 days ago
Territory Sales Consultant, Beachwood
$20k
...Sales Representative One of the most trusted names in energy is growing our sales team. IGS Energy is a purpose-driven energy retailer... ...week, we prioritize a balanced work-life schedule. Work Authorization : Applicants must be authorized to work in the US on a full-...
Base plus commission
Full time
Shift work
IGS Energy Inc
Beachwood, OH
3 days ago
Leaf Home Bath - Outside Sales Rep
$150k - $250k
...Why Work with Leaf Home Bath?An incredible opportunity as a Sales Representative for Leaf Home Bath is now available! Leaf Home Bath is the largest national provider of residential bath remodeling, and we are hiring for sales! We specialize in amazing bathroom remodeling...
Weekly pay
Full time
LeafHome
Bedford, OH
1 day ago
Territory Representative - Cleveland
$72k - $110k
...Benjamin Moore Sales Representative At Benjamin Moore, our success is attributable to the employees who dedicate their time and talents to the brand and exemplify our core values of openness, integrity, community, excellence, and safety. Benjamin Moore employees enjoy...
Work at office
Night shift
Weekend work
Afternoon shift
Benjamin Moore
Cleveland, OH
3 days ago
Showroom Representative
...Inside Sales Representative Support customer satisfaction, growth, profitability, and other performance objectives of the branch office through coordination and maintenance of all inside selling and office procedures. Ensure all policies and procedures in accordance...
Work at office
Monday to Friday
Pella Windows and Doors | Gunton Corporation
Cleveland, OH
18 hours ago
Contact Representative (Call Center)
...professionally, while providing a customer experience that offers consistent and accurate information in a timely manner. The Contact Representative's primary function is to respond to inquiries in a high-stress environment involving high customer volume and sensitive content...
US Department of War
Cleveland, OH
2 days ago
Neighborhood Outreach Representative
$17 per hour
...Neighborhood Outreach Representative Joyce Factory Direct has been an industry leader in home remodeling since 1955, specializing in sunrooms, windows, baths, and doors. We proudly serve multiple markets including Cleveland, Pittsburgh, Charlotte, Columbia, Asheville...
Base plus commission
Hourly pay
Local area
Flexible hours
Joyce Factory Direct - Cleveland
Cleveland, OH
22 days ago
Admissions Representative - Full Time
...Admissions Representative - Full Time The Admissions Representative is responsible for recruiting and enrolling qualified students in accordance... ...-level) is preferred. Licensure: No requirements. Prior Work Experience: Previous sales experience is preferred....
Hourly pay
Full time
Work experience placement
Casual work
Work at office
Monday to Thursday
Afternoon shift
Valley Training Centers LLC
Cleveland, OH
4 days ago
Accounts Receivable Representative
...Accounts Receivable Representative Location: Independence, OH, US, 44131 Requisition Number: 226108 Cintas is seeking an Accounts Receivable Representative. Responsibilities include all accounts receivable related functions, including keeping track of assigned accounts...
Full time
Work at office
Local area
Shift work
Day shift
Cintas
Independence, OH
4 days ago
Contact Representative (Call Center)
Job Posting Defense Finance and Accounting Services (DFAS) mission is to lead the DoD in finance and accounting by ensuring the delivery of efficient, exceptional quality pay and financial information. Telework availability is limited and will only be provided on a ...
Remote work
US Government Jobs
Cleveland, OH
2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Prior Authorization Representative. Be the first to apply!