This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.
Job Responsibilities - Prioritize incoming prior authorization requests
- Evaluate and triage prior authorization rejections to determine validity of the prior authorization
- Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization
- Review patient chart documentation to ensure accuracy of prior authorization submissions
- Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication
- In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier
- When justifiable, initiate appeals for denied authorizations
- Maintain patient files on Prior Authorizations tracker
- Compose letters for various situations to include medical necessity letters and appeal letters
- Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations
- Contact patients via the platform to update the status of their prior authorization
- Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress
- Demonstrate and apply knowledge of medical terminology
- high proficiency of general medical office procedures including HIPAA regulations
- Communicate with pharmacies/insurance carriers via phone, fax, or written communication
- Maintain a level of productivity suitable for the department
- Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
