Prior Authorization Representative

Job Title: Prior Authorization Representative

Client: Medical Device Manufacturing Company
Duration: 24 Months – Possible Extension
Location: Virtual / Remote
Shift: 1st Shift
Experience: 2+ Years Relevant Experience

Job Summary

Handle insurance verification, prior authorizations, payer follow-up, and authorization denials to support patient access to therapies. Provide customer service and maintain accurate authorization and customer records.

Key Responsibilities

• Verify insurance coverage, benefits, and authorization requirements.
• Submit and track prior authorization requests.
• Collect clinical notes, forms, and required documentation.
• Follow up with payers, physician offices, and other stakeholders.
• Support appeals, retro authorizations, denials, and special cases.
• Apply knowledge of ICD-9/10 and CPT codes.
• Communicate with physician offices, payers, sales teams, and utilization reviewers.
• Resolve customer inquiries and product-related questions.
• Process orders, shipping inquiries, returns, credits, and pricing adjustments.
• Trace lost shipments and coordinate with shipping teams.
• Document quality complaints and maintain accurate records.
• Support inventory activities, EDI, forecasting, replenishment, and stock allocation as needed.

Required Skills

• 2+ years relevant experience.
• Prior authorization and insurance verification experience.
• Strong knowledge of payer authorization processes.
• Familiarity with ICD-9/10 and CPT codes.
• Advanced Microsoft Excel skills.
• Ability to learn and use multiple CRM systems.
• Excellent communication and customer service skills.
• Strong organization, multitasking, and attention to detail.
• Critical thinking and problem-solving skills.
• Ability to work independently and with internal/external customers.

Preferred / Additional

• Healthcare payer-process experience.
• Authorization denials and appeals experience.
• Customer orders, shipping, returns, credits, or inventory experience.
• EDI, forecasting, and replenishment experience.
• Ability to identify process issues and recommend solutions.

As a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.