Department: Prior Authorizations & Referrals

Location: 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148

Compensation: $20.00 - $23.00 / hour

Description

We are seeking a solution-oriented and charismatic Customer Service Representative that will be responsible for assisting patients who require specialty care and medication prior authorization requests. This position requires strong customer service skills, attention to detail, and the ability to communicate effectively in both English and Spanish. The role involves coordinating with providers, insurance companies, and pharmacies to ensure timely approval of necessary medications and treatments.

What You'll Do

• Handle a high volume of incoming calls efficiently while addressing patient and provider inquiries regarding prior authorizations.
• Identify patients’ needs, clarify information, research issues, and provide solutions related to prior authorization requests.
• Provide courteous and professional customer service to patients, providers, and pharmacies regarding prior authorization status and requirements.
• Verify insurance eligibility and coverage for prior authorization requests, including prescription medications.
• Initiate, prepare, and submit prior authorization requests for medications and specialty treatments to insurance companies.
• Follow up on pending medication authorizations, ensuring all required documentation (e.g., clinical notes, formulary guidelines) is provided.
• Request and review medical records from other providers as needed to support prior authorization requests.
• Communicate with prescribers and pharmacy staff to address prior authorization rejections, alternative medication options, and appeal processes.
• Ensure all prior authorization requests are submitted accurately and promptly in accordance with payer guidelines.
• Track, document, and maintain records of all prior authorization activities, including approvals, denials, and follow-ups, in the patient’s electronic medical record (EMR).
• Educate patients on insurance formularies, step therapy, and medication alternatives if prior authorization is denied.
• Maintain up-to-date knowledge of insurance guidelines, coverage policies, and managed care regulations related to medication authorizations.
  
  

Qualifications

• High school diploma or equivalent required.
• One (1) to three (3) years of experience in medical customer service, prior authorizations, or a related field.
• Experience with medication prior authorizations, pharmacy benefits, or managed care preferred.
• Strong knowledge of insurance coverage policies, formularies, and prior authorization guidelines.
• Ability to interpret insurance benefits and explain prior authorization processes to patients and providers.
• Spanish fluency is required.
• Strong verbal and written communication skills; must be able to communicate in a professional and courteous manner.
• Proficiency in Microsoft Office applications and insurance eligibility databases.
• Experience with electronic medical record (EMR) systems such as eClinicalWorks (eCW) is a plus.
• Excellent data entry, typing, and organizational skills to track and manage prior authorization requests effectively.
  
  

Environmental Job Requirements and Working Conditions

• Our organization follows an in-person work structure where the expectation is to work onsite daily. This position will report to our corporate office at 8880 W Sunset Rd, Suite 320, Las Vegas, NV 89148.
• The total pay range for this role is: $20-23 per hour. This salary range represents our national target range for this role.