Customer Service Rep

The company is confidential and is seeking a Customer Service Representative II to support patient access to therapies. The role verifies insurance coverage, identifies and obtains prior authorizations, coordinates documentation, follows up on authorization status, and assists with appeals and special cases while communicating with healthcare and payer stakeholders.

Responsibilities:

• Validates insurance patient’s coverage, communicate any issues with benefits or coverage to the appropriate managers
• Checks the requirements for prior authorization and initiates as required
• Coordinates required paperwork, clinical notes and forms for submission to support request and initiates as required
• Follows up frequently to ensure visibility on authorization status throughout the approval process
• Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of Client therapy codes
• Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders
• Advanced Client Excel skills. Ability to learn and use multiple CRM software programs as needed
• Good organizational skills with ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail

Requirements:

• Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
• Basic ICD9/10 and CPT code familiarity
• expert knowledge on subset of Client therapy codes
• Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders
• Advanced Client Excel skills
• Ability to learn and use multiple CRM software programs as needed
• Good organizational skills with ability to handle multiple inquiries at the same time and critical problem-solving skills with high attention to detail