>Handle Authorization submissions and follow ups for all Insurance
Payors including Medicare, Medicaid’s, HMO and PPO’s.
>Answers incoming calls received through the toll free
Pre-Authorization Support ACD and provide appropriate call/case handling.
>Performs initial benefit verification and pre-surgical
authorization for new pre-surgical cases by working closely with all payers.
>Documents case status, actions, and outcome in the
Pre-Authorization Support contact management database utilizing who, what,
where, when and how.
>Communicates and builds relationships with HCP offices and sales
representatives in regard to all inquiries for the handling of cases, missing
case information, benefits.
>Responsible for notifying the appropriate internal departments
based on receipt of information that department needs to be aware of including
complaint handling/ adverse event notifications.
>Utilizes customer service skills in engaging with customers,
communications with Sales representatives, and working in teams in a call
center environment to expedite processing of cases.
>Updates patient insurance and demographics information as needed.
>Easily manages multiple authorization requests at once
>Follows-up on post-claim denials.
>Outbound calls to Doctor’s
office to secure authorizations and to make authorization request for a patient’s upcoming surgery or scheduled procedure.
>Outbound calls to update
patients about the status of their authorization.
>Outbound calls to payor’s
to verify authorization provided by the doctor’s office before encoding and
approving authorization on patient’s file.
>Practice of strict HIPAA compliance.
