Job duties and responsibilities:
- Obtains prior-authorizations and referrals from insurance companies prior to procedures or Surgeries utilizing online websites or via telephone.
- Monitors and updates current Orders and Tasks to provide up-to-date and accurate information.
- Provides insurance company with clinical information necessary to secure prior-authorization or referral.
- Good understanding of the medical terminology and progress notes.
- Works in alignment with Central Scheduling and Pre Encounter Departments.
- Obtains necessary electronic referrals needed from scheduled specialty appointments.
- Obtains and/or reviews patient insurance information and eligibility verification to obtain prior-authorizations for injections, DME, Procedures, and surgeries.
- Request retro-authorizations when needed.
- Communicates with practices when prior-authorization is unable to be obtained and requires peer-to-peer and/or different study.
- Document the detail notes and attach the approved Auth/Referral to patient encounters.
- Software preferences: All Scripts, eCW, ModMed, EPIC.
- Should be willing to work in Night shift. Work from office only.