PRIOR Authorization Specialist

SUMMARY OF RESPONSIBILITIES

The position of Prior Authorization Specialist is responsible for processing prior authorization requests for Surgical procedures, prescriptions, Imaging, PT etc.

Job description:

(1) Processes prior authorization requests relating to procedures, radiology, Physical Therapy, prescriptions from pharmacists. This may include receiving a request form via fax or telephone; reviewing the patients chart to verify the Medical record, prescription, patient data, and the proper diagnoses; uploading patients office notes; requesting prior authorizations by speaking personally with the insurance company representatives by phone or via internet portals, receiving immediate authorization or requesting to be placed onto pending queue for a response within 24-72 hours; expediting urgent requests to generate a same day response; answering questions from insurance company representatives; monitoring incoming faxes for authorizations and adding the authorizations and confirmation numbers to the patients charts; and delivering the authorizations to the pharmacist, or otherwise notifying pharmacist of determination.

(2) Processes prior authorization requests relating to procedures, imaging, physical therapy prescriptions from provider teams via EMR message in an efficient and timely manner.

(3) Requests clarification regarding diagnosis codes and office notes from provider teams as needed via EMR message.

(4) When necessary, monitors incoming fax messages and distributes them to appropriate personnel or chart in an efficient and timely manner.

(5) Assistant with scanning, as well as duties of Prior Authorizations Specialist (Imaging), when necessary.

(6) Performs other related duties as assigned.

Prerequisites:

• Minimum 1 year of experience in Pre-Auth in Procedures (preferred), Peer to Peer Review, Auth related appeals/denials, well versed with EVBV (Eligibility Verification and Benefit Verification).
• Excellent oral and written communication skills
• Knowledge of current medical terminology to communicate with physician, staff, and patients
• High level of attention to detail
• Strong organization, filing, and time management skills
• Basic computer literacy and typing
• Patient focused
• Good communication skills with RCM knowledge
• Knowledge of third party payer regulations including Medicare, Medicaid, Veterans Affairs (VA) and commercial insurances.
• Ok with Night shift.
• Ok with Work from office - Location: Navi Mumbai