Prior Authorizations

The Insurance Prior Authorization Specialist is responsible for all aspects of the prior authorization process. Complete, timely, and accurate identification and submission of prior and retro authorization requests to the insurance. Interacts with insurance agents, medical staff, and other departments as necessary to request documentation pertaining to the process. Advises Providers of procedures that can and cannot be performed in compliance with insurance standards and protocols. Requests additional Medical Records, Imaging, and Documents to properly obtain prior authorization. Communicates effectively and professionally to our patients, provider’s staff, and insurance companies. Needed 1Y of proven experience with ECW and authorizing medical procedures.

Essential Functions
Research Provider’s Requests and Progress Notes
Review patient’s benefits and coverage
Identify and report trends in prior authorization
Proactively advises Providers of authorized procedures to decrease denial rates.
Alert other departments of inconsistencies
Communicate with Patients and request any missing insurance information
Requests additional Medical records in order to comply with insurance guidelines and protocols

Prior Authorizations

The Insurance Prior Authorization Specialist is responsible for all aspects of the prior authorization process. Complete, timely, and accurate identification and submission of prior and retro authorization requests to the insurance. Interacts with insurance agents, medical staff, and other departments as necessary to request documentation pertaining to the process. Advises Providers of procedures that can and cannot be performed in compliance with insurance standards and protocols. Requests additional Medical Records, Imaging, and Documents to properly obtain prior authorization. Communicates effectively and professionally to our patients, provider’s staff, and insurance companies. Needed 1Y of proven experience with ECW and authorizing medical procedures.

Essential Functions
Research Provider’s Requests and Progress Notes
Review patient’s benefits and coverage
Identify and report trends in prior authorization
Proactively advises Providers of authorized procedures to decrease denial rates.
Alert other departments of inconsistencies
Communicate with Patients and request any missing insurance information
Requests additional Medical records in order to comply with insurance guidelines and protocols