-
Overall performance rating of below indicated essential job duties:
-
Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members, providers, and additional resources as needed. Appeals for additional or change of services, authorization extension, and refers to additional resources when necessary.
-
Records insurance information utilizing standardized documentation practices through the entire Pre-cert/Prior Authorization process for communications with pertinent staff.
-
Independently maintains and works from the electronic medical record and additional databases.
-
Obtains, interprets, and submits clinical documentation pertinent to the specific services requiring prior authorization to support reviews by the payer. Escalates to the Physician’s office, effected service area, and any other applicable department when authorization is not obtained and/or benefits are inadequate.
-
Obtains and documents prior authorization approval from insurance companies for services and Communicates professionally and timely to the physician/clinical staff regarding authorization status or delays.
-
Follows up on denied authorization requests, escalates to Physician’s office , effected service area, and any other applicable department and relays the necessary denial detail to the provider to facilitate the appeals and/or Peer to Peer reviews.
-
Provides support to other departments to clarify claim submission and claim denial appeal efforts. May work to resolve claims denials related to the prior authorization process and may include account review, claim review, appeal preparation, and submission.
