Full Time - Prior Authorization Representative

JOB SUMMARY:

This position will complete training at our North Phoenix office located at 1929 W. Lone Cactus Dr., Phoenix, AZ 85027. Upon successful completion of training, the role will be based at our laboratory located at 4313 E. Cotton Center Blvd., Phoenix, AZ 85040.

Hours: Monday-Friday 7:00am - 3:30pm or 8:00am-4:30pm

As a Prior Authorization Representative , you would work in a fast-paced environment managing pathology patient accounts. Core responsibilities include reviewing laboratory testing orders, gathering and verifying necessary documentation, submitting prior authorization requests to insurance companies, monitoring the status of those requests, and communicating updates or additional requirements to providers and leadership in a timely manner. Employees are responsible for following all Company policies and procedures. These policies and procedures will include adherence to regulatory standards such as CAP, HIPAA, CLIA and OSHA, including safety standards in performing all aspects of the functions below.

ESSENTIAL FUNCTIONS:

• Review incoming laboratory test orders to determine prior authorization requirements.
• Verify patient demographic information and insurance eligibility for all incoming test orders. Confirm and update necessary information to ensure proper processing of authorization requests and claims.
• Ensure medical payor policy requirements are met and share feedback with managers and physicians as needed.
• Track and document authorization progress in workflow software. Record authorization numbers for billing.
• Communicate effectively with physicians, patients, and team members. Build meaningful relationships with internal and external teams.
• Identify opportunities for workflow improvement. Provide ongoing feedback to ensure timely submission and resolution of authorization requests.
• Compile trends and stay up to date on relevant changes to payor authorization guidelines.
• Strictly adhere to confidentiality and HIPAA guidelines. Attend department meetings as required.

PHYSICAL/MENTAL DEMANDS, ENVIRONMENT :

• Ability to sit for extended periods of time while working at a computer workstation.
• Frequent use of hands and fingers for typing, data entry, and navigating multiple software systems.
• Ability to view and read information on a computer screen for prolonged periods, including laboratory orders, insurance portals, and electronic health records.
• Ability to communicate effectively with physicians, insurance representatives, and internal teams via phone, email, and messaging platforms.
• Ability to manage multiple tasks simultaneously, prioritize workload, and meet deadlines in a fast-paced environment.
• Ability to apply critical thinking, attention to detail, and sound judgment when reviewing medical and insurance documentation.
• Ability to maintain focus and accuracy while handling repetitive tasks and high volumes of work.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

EQUIPMENT USED:

• Desktop or laptop computer
• Multiple computer monitors
• Telephone and headset
• Office equipment such as printers, scanners, and copiers
• Laboratory Information System (LIS), electronic health records (EHR), and insurance payer portals
• Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and workflow tracking systems

SUPERVISORY RESPONSIBILITIES:

None

MINIMUM QUALIFICATIONS:

• Minimum of 2 years experience in the healthcare field is required
• Minimum 1 year experience in referrals/authorizations, eligibility, or registration.
• Strong customer service and organizational skills are required.
• Basic Microsoft Word, Excel, and PowerPoint skills required.
• Demonstrate working knowledge of verifying patient insurance coverage (eligibility verification) and obtaining necessary approvals for treatment (prior authorization) under Medicare, Medicaid, and commercial insurance plans.
• Ability to work both independently and in a team setting

Work Environment:

The work environment characteristics described here are representative of those individuals and employee encounters while performing the duties of this job. Clin-Path provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, and gender identity. Clin-Path complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This applies to all terms and conditions of employment including, recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.

Benefits:

Clin-Path Associates offers nationally competitive compensation and benefits. Our benefits program provides a comprehensive array of services to our employees including, but not limited to health insurance (Primarily covered by the company), dental insurance (100% covered by the company) vision insurance, paid time off, retirement contributions (401k), & flexible spending account (FSA).