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9 hours ago
Prior Authorization Specialist Role
We are seeking a skilled Prior Authorization Specialist to join our team. The successful candidate will be primarily responsible for obtaining all types of prior authorizations, including biologic medications, procedures, prescriptions, and out-patient testing.
Responsibilities:
- Review and process prior authorization requests for medical services, procedures, and medications
- Verify insurance (pharmacy) information and eligibility
- Handle patient inquiries regarding authorizations
- Provide necessary prior authorization documentation to patients for completion and signature; review all forms for completeness and accuracy
- Accurately document all patient, pharmacy, and insurance carrier interactions in EMR
- Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
- Ensure accurate and timely documentation of authorization requests and approvals
- Collaborate with medical billing team to resolve any issues or denials
- Maintain up-to-date knowledge of insurance guidelines and procedures
- Complete other tasks as assigned by providers through EMR/EHR
- Copy, fax, and mail documents and information as requested by insurance carrier
- Schedule follow-up appointments, biologic injections, and photodynamic therapy treatments
- Assist pathology department with notifying patients of pathology results via telephone
- Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient's rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
- Provide safe patient-centered, compassionate, and competent patient care
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