Prior Authorization Representative

🔥 9 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Representative

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Quadax, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

☁️ SaaS

🤝 B2B

🤖 Artificial Intelligence

SaaS • B2B • Artificial Intelligence

Quadax, Inc. is a healthcare-focused revenue cycle management company that provides software and services to automate and optimize billing, claims processing, denial management, patient access, and reimbursement for hospitals, laboratories, physician groups, DME providers, and post-acute care organizations. Combining more than 50 years of RCM expertise with AI-powered analytics and intelligent automation (branded as iQ), Quadax helps healthcare organizations reduce denials, accelerate payments, improve cash flow, and enhance the patient experience. The company offers enterprise-level SaaS solutions and managed services tailored to the needs of healthcare providers and billing partners.

📋 Description

• 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.

🎯 Requirements

• 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