Prior Authorization (Finance)

Obtaining and Processing Prior Authorizations and Referrals:
Gathering and submitting necessary documentation to insurance companies for prior authorization of services, procedures, medications, and obtaining insurance referrals.

Obtaining and Processing Prior Authorizations and Referrals:
Gathering and submitting necessary documentation to insurance companies for prior authorization of services, procedures, medications, and insurance referrals.

Verify Insurance Coverage and Benefits:
Ensuring that patients' insurance policies cover the requested services and that any necessary pre-certification or authorization requirements are met.

Tracking Authorization Status:
Monitoring the status of prior authorization requests, following up on pending requests, and ensuring timely processing.

Communicating with Healthcare Providers and Staff:
Collaborating with physicians, nurses, and other healthcare professionals to ensure accurate and timely processing of authorizations.

Maintaining Accurate Records:
Keeping detailed records of authorization requests, communications, and outcomes.

Ensuring Compliance:
Adhering to relevant regulations and policies related to prior authorization, including HIPAA.


Additional Skills and Knowledge:

Knowledge of medical terminology and insurance protocols .
Strong organizational skills and attention to detail .
Excellent communication and interpersonal skills .
Ability to use computer systems and software used for insurance billing. and authorization.

Experience with using Electronic Health Records (NextGen preferred).