Prior Authorization Representative

Quadax, Inc.

. Review case and insurance coverage information to customize prior authorization requests for insurance companies or physician’s offices .

Posted 10/15/2026full-timeMiddleburg Heights • Ohio • United StatesMid-LevelSenior💰 $19 - $22 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization processes, including navigating payer portals and customizing requests based on insurance requirements. Proficient in medical terminology and skilled in maintaining confidentiality while meeting productivity and quality goals.

Highest-signal resume keywords

Prior Authorization ExperienceHealth Insurance BillingMedical Terminology KnowledgeMicrosoft Excel ProficiencyExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationHealth Insurance BillingMedical TerminologyDetail OrientationProductivity Standards

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationMultitasking AbilityConfidentiality Maintenance

Tools & Technologies

Microsoft ExcelMicrosoft WordPayer Portals

Industry Keywords

SOP ComplianceKPI GoalsBenefit Investigation Process

About the role

Key responsibilities & impact

Review case and insurance coverage information to customize prior authorization requests for insurance companies or physician’s offices
Navigate payer portals to initiate and obtain prior authorization status
Provide insurance company representatives with an overview of services submitted for prior authorization
Answer reimbursement process questions and direct testing-specific and treatment questions
Complete letters of medical necessity based on client or insurance requirements and fax them to ordering physician’s offices
Follow up with insurance companies or physician’s offices as needed
Complete assigned worklist tasks according to benefit investigation process standards and report when assistance is needed
Participate in team meetings by sharing case details
Comply with applicable SOPs
Meet or exceed productivity and quality KPI goals
Perform other duties as assigned

Requirements

What you’ll need

High School diploma or GED
Previous health insurance billing experience
Working knowledge of medical terminology
Proficient and attentive to details
Excellent written and verbal communication skills
High attention to detail
Ability to maintain confidentiality
Proficient in using Microsoft Excel and Word
Ability to multitask, establish priorities, and work independently
Applicants must reside in Ohio