The Prior Authorization Specialist is responsible for all aspects of the prior authorization process. Responsibilities include collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization to proceed with service.
- Minimum 6 months to 1 year experience
- Excellent written and verbal English communication skills
- Working knowledge of current Microsoft Office.
- Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations
- Requires knowledge of benefit verification, Referrals & prior authorization with speed and accuracy.
- Deep knowledge of referral vs authorization vs pre-certification
- Proactively manages and maintains all outstanding authorization accounts to increase billing of clean claims
- Knowledgeable on the insurance plan types etc. PPO, HMO, and government payers.
- Familiar with insurance provider portals.
- Familiar with coding and medical necessity for requesting Prior authorizations
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.