
Clinical Authorization Coordinator
12 hours ago
MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team.
The Prior Authorization Specialist will be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include 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.
This role requires strong communication and interpersonal skills, as well as attention to detail and organizational abilities.
Requirements:- Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
- Strong knowledge of insurance verification processes and payer/billing guidelines.
- Excellent communication and interpersonal skills to work effectively with patients, providers, and insurers.
- Detail-oriented with strong organizational skills
- Ability to work independently and meet deadlines
- Comfortable working in a remote, work-from-home setup
- Amenable to work in a graveyard shift
We offer a highly competitive salary and benefits package, including HMO reimbursement, fixed weekends off, and exclusive specialized training programs.
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