Authorization Specialist SSC

• →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

• High School Diploma or equivalent (GED) required

The employee may frequently lift and/or move up to 10 pounds and may occasionally lift and/or move up to 25 pounds.