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

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Authorization Specialist SSC