Authorization Representative Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the authorization representative job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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O Harvey

Orion

Harvey

9788 Ryan Lodge

Dallas

+1 (555) 716 2129

9788 Ryan Lodge

Dallas

Phone

p +1 (555) 716 2129

Experience Experience

Los Angeles, CA

Authorization Representative

Los Angeles, CA

Rice LLC

Los Angeles, CA

Authorization Representative

Responsible for obtaining prior and ongoing authorization for service in a timely manner
Reviews billing questions with the Billing Department
Responsible for maintaining timely and accurate database of financial/authorization information
Functions as a member of a team providing cross coverage for peers
Provides superior customer service to internal and external clients, customers and patients
Responsible for the timely and accurate verification of primary insurance as directed by insurer
Performs other duties as requested by Manager and/or CFO

San Francisco, CA

Hwa-authorization Representative

San Francisco, CA

Rice-Terry

San Francisco, CA

Hwa-authorization Representative

Enlisting non-contracted service providers to perform repairs for HWA customers
Inbound call center environment from service providers and current internal and external customers nationwide; additional admin/clerical duties; outbound follow-up with service providers and customers with outstanding questions/concerns
Provide resolution to service provider and customer concerns, deescalate concerns by providing professional, courteous, and clear communication of repairs and warranty information
Receive service provider repair info, record in claim notes and provide coverage/repair decision
Responsible for establishing rapport with service providers and new and existing customers.
Facilitating the scheduling of service appointments between service providers and customers in a timely, professional manner
Persuasive, “selling” (rather than “telling”), communication style a plus

present

Houston, TX

Prior Authorization Representative

Houston, TX

Larson and Sons

present

Houston, TX

Prior Authorization Representative

present

Maintaining email resource and internal log and working closely with supervisors and managers
Contacting insurances (by phone, e-mail and regular mail) for eligibility, benefits, network status and authorization, documenting information
Verify eligibility within the database system to members and providers
Analyze faxed requests and documentation to determine coverage and approval utilizing criteria; utilize nurses for medical reviews when necessary
Process requests for Prior Authorization
Acts as a liaison between the payer and clinic schedulers/medical support staff
Code each diagnosis of service and procedures according to standards

Education Education

Bachelor’s Degree in Expertise

Ashford University

Bachelor’s Degree in Expertise

Skills Skills

Flexible and adaptable to quick changing environment(s)
Strong service orientation with professional and courteous performance
Ability to work as a team player in a professional environment
Strong computer/typing skills
Ability to adapt in a dynamic work environment learns
Excellent oral and written communication skills
Ability to handle challenging customers in a
Strong interpersonal skills
1-2 years experience in Specialty Pharmacy
Problem-solving

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8 Authorization Representative resume templates

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Prior Authorization Representative Resume Examples & Samples

Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria
Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions
Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement
Work collaboratively with other associates and supervisor to ensure that best practices are shared
Other special projects as assigned
Ability to work required shift of Monday - Friday, 1:30 pm - 10:00 pm
2 – 3 years of call center and/or customer service experience
Conflict resolution skills; excellent organizational skills
Superior written and verbal communication and presentation skills
Ability to handle challenging customers in a professional manner
Ability to adapt in a dynamic work environment learns quickly, solve problems and make decisions
Willingness to work a flexible schedule for peak call times
LI-DH1

Senior Prior Authorization Representative Resume Examples & Samples

Serve as a point of escalation for calls from members, physicians and providers requiring a higher degree of expertise or discretion to resolve customer issues and ensure timely resolution. May take overflow calls from members during peak call times
Provide assistance to PAR team with issues needing technical expertise and client specific plan interpretation. Provide on-the-job training for new or existing reps. Mentor PAR team to improve their understanding and skills. Ensure PARs are familiar with resource materials including manuals and systems
Act as liaison for other operational departments to research and resolve member and client issues. Be responsible to screen, review and direct all customer service generated forms to appropriate internal areas facilitating member and client issues resolution
Maintain service levels and performance guarantees. Maintain accurate and complete documentation of all inquiries
Provide support and backup for supervisors. Assist with work plan development and work distributions for PARs
Three to five years’ experience in a customer service setting; preferably nine months in an ESI call center environment
Ability to work a flexible shift to include evenings and weekends
Extensive knowledge of ESI products and services a must
Experience training and coaching less experienced staff – patience to explain details and processes repeatedly
Excellent phone presentation and communication skills
Demonstrated ability to handle challenging customers in a professional manner
Ability to adapt in a dynamic work environment and make decisions with minimal supervision Advanced problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions

Prior Authorization Representative Resume Examples & Samples

Handle inbound telephone and written inquiries from
Provide information to clients, participants,
Flexibility to work any shift during regular business hours of operation (Monday-Friday, 6:00am – 8:00pm; Saturday-Sunday, 6:00am – 6:00pm)
2-3 years relevant experience (i.e., call center, collections, healthcare, hospitality, retail, pharmacy)
Ability to handle customer inquiries in a professional manner
Willingness to work a flexible schedule

Prior Authorization Representative Resume Examples & Samples

Ability to work a shift Tuesday - Saturday, 11:30 am to
8:00 pm
2-3 years relevant experience (i.e., call center,
Ability to handle challenging customers in a

Authorization Representative Resume Examples & Samples

Cross-trained to staff all areas of Authorization supporting any facility, including but not limited to verification, pre-certification, eligibility, benefits including copays, deductibles and out of pocket expenses
May be required to flag accounts for high dollar financial clearance. Identifies and utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending, denied or in the appeal process
Maintains productivity and quality expectations set forth by department
Performs some registration input in order to ensure accurate patient information for the authorization process
Identifies and utilizes appropriate reports to contact insurance payers for resolution to accounts that are pending, denied or in the appeal process
Communicates with physician offices to obtain clinical information and/or coordinate peer-to-per conversations
Minimum of 2 years of experience in a customer facing role with in person or phone contact
Candidate must demonstrate PC skills efficiency
Ability to multitask within multiple accounts in high volume insurance verification processes
An Associate's degree may substitute for up to one year of the stated experience
A Bachelor's degree my substitute for up to two years of the stated experience

Authorization Representative Resume Examples & Samples

Plumbing, HVAC, Electrical, Appliance, Pool trade experience desirable
Fundamental understanding of Home Warranty polices
Working knowledge of Microsoft Office and Windows based programs

Prior Authorization Representative Resume Examples & Samples

LI-JT1
Low incident of quality monitoring failures
Excellent attendance record is required
Conflict resolution skills; excellent organizational skills; Superior written and verbal communication and presentation skills; Strong interpersonal skills
Ability to handle challenging customers in a professional manner; Ability to adapt in a dynamic work environment learns quickly, solve problems and make decisions; Willingness to work a flexible schedule for peak call times

Authorization Representative Resume Examples & Samples

Provides superior customer service to internal and external clients, customers and patients
Responsible for the timely and accurate verification of primary insurance as directed by insurer
Responsible for obtaining prior and ongoing authorization for service in a timely manner
Responsible for maintaining timely and accurate database of financial/authorization information
Assists as needed in the processing of any appeals fro payment denials
Reviews billing questions with the Billing Department
Performs other duties as requested by Manager and/or CFO
Functions as a member of a team providing cross coverage for peers

Customer Return Authorization Representative Resume Examples & Samples

Handle inbound/outbound customer phone calls
Extensive use of Microsoft Office and internal database systems that document calls and progress of case, and pending case management
Coordinate product resolutions with carriers, installers and warehouse
Associate’s Degree in business or accounting required. Bachelor's Degree preferred
Minimum 1 years of experience in a call center, customer service or a related field
Expert communication and customer service skills; able to effectively handle dissatisfied customers
Self-motivated with excellent administration, organization and time management skills
Strong Microsoft Office Suite skills with ability to quickly learn new applications

Prior Authorization Representative Resume Examples & Samples

Process requests for Prior Authorization
Treatment request
Inpatient hospitalization
Phone requests
Verify eligibility within the database system to members and providers
Code each diagnosis of service and procedures according to standards
Handle telephone requests timely and accurately
Update plan resources
Analyze faxed requests and documentation to determine coverage and approval utilizing criteria; utilize nurses for medical reviews when necessary
High School Diploma required / MA Certificate preferred
Strong knowledge in medical terminology required
ICD-9/ CPT Coding experience preferred
2+ years health plan or health care office experience preferred
Problem-solving
Strong computer/typing skills
Strong service orientation with professional and courteous performance
Flexible and adaptable to quick changing environment(s)
Ability to work as a team player in a professional environment

HHA Prior Authorization Representative Resume Examples & Samples

HS Diploma, GED, or technical certification in related field or equivalent experience
3+ years experience in related field
Works independently within established procedures; may receive general guidance on new assignments

Authorization Representative Resume Examples & Samples

Verify Insurance Eligibility
Obtain Authorizations
Participate in various projects and/or meetings, and complete other tasks as assigned by management

Authorization Representative Resume Examples & Samples

Responds to patient referrals for tests, procedures, and specialty visits. Obtains authorizations required by various payors; including verification of patient demographic information, codes, dates of service, and clinical data. Re-certifies services when necessary
Authorizes and schedules appointments. Answers questions regarding the authorization process and supplies information to physicians, patients, and third party payers. May, depending on department/location, inform patients about necessary preparation for procedure or test
Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Provides information about the referral process to physician and staff and informs them of eligibility issues. Works with staff and patients regarding denials and appeals
Documents and maintains records of all referral activity and authorizations
Performs other related duties as assigned. This may include cross-coverage in other areas

Hwa-authorization Representative Resume Examples & Samples

Education required to competently achieve responsibilities
High School Diploma or GED required; some college preferred
Previous mechanical/technical experience a plus
Minimum of 1-3 years of previous call center experience within a customer facing environment preferred
Must be socially focused with a “How can I help you?” attitude
Prefers to work in a fast-paced environment
Must be a proficient, accurate, and effective note taker
Persuasive, “selling” (rather than “telling”), communication style a plus
Strong desire to work within a team oriented environment with high level of collaboration and teamwork
Type 30+ WPM, and ability to navigate through several internet based applications
Proficient in Windows-based computer programs with excellent navigation skills
Dependable and punctual in assigned work schedule required
Inbound call center environment from service providers and current internal and external customers nationwide; additional admin/clerical duties; outbound follow-up with service providers and customers with outstanding questions/concerns
Facilitating the scheduling of service appointments between service providers and customers in a timely, professional manner
Negotiating and processing buyouts directly with customers
Receive service provider repair info, record in claim notes and provide coverage/repair decision
Provide resolution to service provider and customer concerns, deescalate concerns by providing professional, courteous, and clear communication of repairs and warranty information
Route misdirected and supervisor calls accordingly based on customer needs
Responsible for establishing rapport with service providers and new and existing customers
Enlisting non-contracted service providers to perform repairs for HWA customers

Senior Prior Authorization Representative Resume Examples & Samples

Contact benefit providers and/or payers to gather policy benefit limitations and ensure services provided are reimbursable; deductible amounts, co-payments, effective date, levels of care, authorization, visit limitations, documentation required to process claims). Documents all communication Ensure accounts requiring authorizations and re-authorizations are identified, secured, and updated in Rx Home prior to each shipment. Notify service delivery staff if authorization cannot be obtained
Facilitate communication for acceptance or denial of new patient referral/change in therapy. Provide updates to physician and sales on the status of pending referrals. Provide billing and reimbursement requirements; assist with billing, payer, and patient issues; submit required documentation. Notify patient or responsible party of possible financial responsibility before start of service if business rules require
Negotiate pricing based on pricing grids for non-contracted payers; authorize patient services and ensure proper payer pricing is indicated in Rx Home. Contact/inform branch staff if no payer source is available
Update patient information with address/benefit changes per payer request and make correction to ensure payment. Conduct financial quality assurance reviews (DVR, shipment QA, insurance and authorization screens, etc.) of patient and payer related data post start of care and shipment to validate and ensure services provided will be reimbursed. May conduct invoice editing and daily revenue accuracy reconciliation as required for the SDU in accordance with the Invoice Editing processes and essential duties. Special projects as assigned
High school diploma; Bachelor’s Degree preferred
3 – 5 years of experience
Excellent Customer Service Skills - patience to explain details and processes repeatedly, excellent phone presentation and communication skills
Advance problem solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions
Ability to work a flexible schedule

Prior Authorization Representative Resume Examples & Samples

2+ years experience as a medical assistant, office assistant or other clinical experience
Knowledge of medical terminology is strongly recommended
Previous experience working with providers and provider networks preferred Call center experience, strongly preferred
Knowledge of diagnosis codes, CPT/HCPC codes is recommended
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Ability to effectively participate in a multi-disciplinary team including internal and external participants
Effective communication, telephonic and organization skills
Sedentary work involving periods of sitting, talking, listening
Work requires sitting for extended periods, talking on the telephone and typing on the computer
Typical office working environment with productivity and quality expectations

Prior Authorization Representative Resume Examples & Samples

Contacting insurances (by phone, e-mail and regular mail) for eligibility, benefits, network status and authorization, documenting information
Reviews and summarizes pre-authorization criteria for medical necessity to aid departments with procedure scheduling and/or financial advocate needs
Familiarity with contracts, payer guidelines, and resources to determine appropriate coverage and eligibility
Acts as a liaison between the payer and clinic schedulers/medical support staff
Maintaining email resource and internal log and working closely with supervisors and managers
Update patient registration with insurance information
Other duties may be required

Prior Authorization Representative Resume Examples & Samples

Identify all outliers and provide feedback to the necessary departments to make certain that the prescriptions are not being delayed
Monitor the pharmacy system for any orders that have Zero Doses Remaining
Monitor the system for any Expired Authorizations that require physician notification
Coordinate information for all outreach of new prescriptions for all departments
1-2 years experience in Specialty Pharmacy

Lead Authorization Representative Resume Examples & Samples

Organizational skills with the ability to multi task prioritize and follow up
Strong decision making, problem solving and conflict resolution ability
Utitilzation of basisc mathmadical functions
Ability to operate in a fast-paced environment, adapt quickly to change, and possess desire to grow with the company
2+ years of Customer Service experience
2+ years of Claims Authorization expierence
Plumbing, HVAC, Electrical, Appliance, Pool/Spa trade experience desirable

Return Authorization Representative Resume Examples & Samples

Handle inbound/outbound customer phone calls and emails
Extensive use of internal database systems that document calls and progress of case in ERP system
Process resolutions with management approval, while maintaining a list of pending cases
All SWAP and Return cases must be processed and follow up with defected units to be returned back to designated Warehouse
Comply with ESP (Enhanced Service Plan) policy and arrange with installation partners

Credit Authorization Representative Resume Examples & Samples

Work with various in-house systems to identify authorization related issues regardless of card type and take appropriate steps to resolve the issue and communicate the appropriate information as needed to the customer in a timely manner. This would include identifying and resolving authorization issues related to backorders
Contact various card issuing bank centers on behalf of Lands' End and the cardholder to remove multiple authorizations on the cardholder's account. This would also include the removal of authorizations, within the guidelines established, relating to orders canceled by the customer or Lands' End
Respond to request for credit card searches, copy of credits issued, refund requests and respond to customer e-mail related authorization questions
Assist with the identification of potentially fraudulent orders or customers and communicate the information to the appropriate area within the company for further investigation
Work with various in-house systems to review orders on hold and determine, within company guidelines, what action to take to resolve the issue
Maintain in house fraud file and related activity. This would include updating customer number report, internal and external address change report and customer suppression report
Assist our internal customers as well as our external customers regarding credit card related issues
Ability to work with PayPal transactions to assist internal and external customers
Assist with chargebacks and various tasks within the area; when the workload warrants
Two plus years Customer Sales, Service and credit authorization experience
Ability to communicate professionally and diplomatically through verbal and written communication with external Lands' End customers and internal departments
Ability to perform at a high level of accuracy with confidential information
Ability to make decisions that may have a financial impact on the company and a service impact on our customers
Strong understanding of the order entry and order fulfillment process
Ability to work with minimal supervision
Willingness to work days, nights, weekends and company holidays as required

Prior Authorization Representative Resume Examples & Samples

Performs all aspects of electronic claims process and rejection resolution
Ensures accounts requiring authorizations and re-authorizations are identified, secured, and updated in RX Home prior to each shipment. Notifies as appropriate if authorization cannot be obtained
Contacts benefit providers to gather policy benefits/limitations to ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
Handles inbound client calls and written correspondence regarding patient eligibility
Provides inbound phone call support to the prior authorization team giving personal attention to the resolution of customer issues having to do with the status of letter requests or physician review process
Supports cross-functional departments in resolution of eligibility issues (claims, contact center, account management, service delivery, etc.)
Negotiates pricing for non-contracted payers and authorizes patient services and ensures proper pricing is indicated in RxHome. Works referrals
Completes other projects and additional duties as assigned
High school diploma or GED required, bachelor’s degree preferred
2-3 years of relevant working experience to include one year of health care experience with medical insurance knowledge and terminology
Intermediate data entry skills and working knowledge of Microsoft Office
Experience training and coaching less experienced staff with patience to explain details and processes repeatedly
Demonstrated ability to handle challenging customers in a professional manner, ability to adapt in a dynamic work environment and make decisions with minimal supervision
Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions