What are the responsibilities and job description for the Prior Authorizations Representative position at Career Strategies?
- Prior authorization submission:
Prepare and submit prior authorization requests to insurance companies, including necessary medical documentation, diagnosis codes, and treatment plans.
- Clinical review:
Analyze medical records to determine if a requested service or medication aligns with medical necessity guidelines and insurance coverage.
- Communication with providers:
Contact healthcare providers to gather additional information or clarify details regarding requested services for prior authorization.
- Follow-up with insurance companies:
Monitor the status of pending prior authorization requests and follow up with insurance companies to obtain timely approvals.
- Patient education:
Explain the prior authorization process to patients, including potential delays and necessary documentation.
- Documentation:
Maintain accurate records of all prior authorization requests, including patient information, insurance details, and approval status.
- Billing support:
Collaborate with billing staff to identify and resolve potential billing issues related to prior authorizatio
- Insurance verification:
Accurately verify patient insurance information, including eligibility, benefits, and coverage details.
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