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