Sr Rep Cust Serv Ops Prior Authorization - US Healthcare Account

Position Summary

The NCMS Prior Authorizations Specialist I is responsible for the initiation of the prior authorization process for medical procedures, medications, and other healthcare services. This entry-level role involves working closely with healthcare providers, insurance companies, and patients to ensure timely approval for treatments.

Essential Functions

• Reviews incoming authorization requests and verify patient eligibility and benefits.
• Initiates prior authorization requests via phone, fax, or online portals.
• Tracks and follows up on the status of submitted authorizations.
• Communicates approval or denial outcomes to healthcare providers and patients.
• Maintains accurate records and documentation of all authorization activities.
• Collaborates with the billing and clinical teams to ensure accuracy of information.
• Complies with HIPAA rules, appropriately safeguarding PHI or other private & confidential information.
• Maintains accurate and detailed notes in the company system.
• Adapts quickly to frequent process changes and improvements.
• Is reliable, engaged, and provides feedback to improve processes and policies.
• Attends all department, team, and weekly company meetings as required.
• Appropriately routes incoming calls when necessary.
• Meets company quality standards.
• Embraces and exemplifies Cardinal Health Values: Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others
  
  

• At least 2 years of college coursework or experience
• At least 2 years of handling Prior Authorization work experience is required
• Experience in using Contact Center phone system such as NICE and/or Genesys is an advantage