Prior Authorization Specialist
MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist will be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include biologic medications, procedures, prescriptions, and out-patient testing. The position will require professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies, and insurance carriers to accurately obtain the required information to process prior authorizations.
Responsibilities
- Review and process prior authorization requests for medical services, procedures, and medications
- Verify insurance (pharmacy) information and eligibility
- Handle patient inquiries regarding authorizations
- Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
- Accurately document all patient, pharmacy, and insurance carrier interactions in EMR.
- Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
- Ensure accurate and timely documentation of authorization requests and approvals
- Collaborate with medical billing team to resolve any issues or denials
- Maintain up-to-date knowledge of insurance guidelines and procedures
- Complete other tasks as assigned by providers through EMR/EHR
- Copy, fax, and mail documents and information as requested by insurance carrier
- Schedule follow-up appointments, biologic injections, and photodynamic therapy treatments
- Assist pathology department with notifying patients of pathology results via telephone
- Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patients rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
- Provide safe patient-centered, compassionate, and competent patient care.
Other details:
Start Date: TBD
Schedule: 8 hours/day Monday-Friday; 40 hours/week
Days Off: Saturday & Sunday
Time zone: TBD
Duration: Full-time