Authorization Specialist SSC - NASHVILLE, TN
 Lincare Holdings | |
 United States, Tennessee, Nashville | |
 Jan 11, 2025 | |
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This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.
Job Responsibilities: * Prioritize incoming prior authorization requests * Evaluate and triage prior authorization rejections to determine validity of the prior authorization * Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization * Review patient chart documentation to ensure accuracy of prior authorization submissions * Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication * In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier * When justifiable, initiate appeals for denied authorizations * Maintain patient files on Prior Authorizations tracker * Compose letters for various situations to include medical necessity letters and appeal letters * Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations * Contact patients via the platform to update the status of their prior authorization * Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress * Demonstrate and apply knowledge of medical terminology * high proficiency of general medical office procedures including HIPAA regulations * Communicate with pharmacies/insurance carriers via phone, fax, or written communication * Maintain a level of productivity suitable for the department * Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format | |