Prior Authorization Representative - 100% Remote - multiple openings

• Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
• Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
• Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

• Education Level: High School Diploma or GED
• 3 years of experience in health care claims/service areas or office support.

• 2 years of experience in health care/managed care setting or previous work experience within division
• Knowledge of CPT and ICD-10 coding.

Andeo Group LLC