Quadax, Inc.

Prior Authorization Representative

Quadax, Inc.  •  Middleburg Heights, OH (Onsite)  •  5 months ago
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Job Description

Key Responsibilities:

  • Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.
  • Navigate through payer portals to initiate/obtain prior authorization status.
  • Provide insurance company representatives with an overview of the services being submitted for prior authorization.
  • Answer questions regarding the reimbursement process and direct testing specific and treatment questions.
  • Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.
  • Follow up with the insurance company or physician’s office as needed.
  • Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.
  • Participate in team meetings by sharing the details of cases worked.
  • Comply with all applicable SOPs.
  • Meet or exceed productivity and quality KPI goals.
  • Perform other duties as assigned.

Education/Experience:

  • 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
Quadax, Inc.

About Quadax, Inc.

Quadax is a trusted leader in revenue cycle management (RCM), delivering innovative solutions that help healthcare providers nationwide accelerate payments, boost reimbursements, and improve financial performance. Our proprietary, industry-leading RCM solutions—spanning advanced in-house billing software, outsourced billing services, and integrated clearinghouse technology—deliver actionable insights and measurable results.

RCM/Billing: Quadax solutions are laboratory- and pathology-specific, designed to improve efficiency, reduce denials, and maximize revenue for all laboratory specialties ranging from clinical to esoteric testing, and DME companies. Services include our integrated clearinghouse to further optimize results. Our experienced teams provide the expertise and support needed to drive better financial outcomes.

EDI Clearinghouse: Our smart platform combines AI-powered analytics, machine learning, and cutting-edge clearinghouse technology to give healthcare organizations greater control over claims, denials, appeals, audits, and revenue integrity. We serve hospitals, labs, and providers nationwide, leveraging long-standing relationships with thousands of payers and decades of industry experience to drive superior outcomes.

What sets us apart? Nearly 40% of our team brings more than a decade of RCM experience, ensuring clients receive personalized support and strategic guidance every step of the way.

At Quadax, your success is our priority. As a trusted RCM leader with over 50 years of experience, deep industry expertise, and advanced technology, we deliver comprehensive, end-to-end solutions that achieve results. Our proven approach is designed to optimize financial performance, improve operational efficiency, and drive better outcomes for healthcare organizations nationwide.

Discover why leading healthcare organizations rely on Quadax for smarter revenue cycle solutions at Quadax.com.

Industry
Healthcare & Social Services
Company Size
501-1,000 employees
Headquarters
Cleveland , Ohio
Year Founded
1973
Website
quadax.com
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