As a Prior Authorization Specialist, my work majors on:
• Submit and follow up on preauthorization requests for medical services, diagnostic tests, medications, or procedures.
• Confirm patient insurance eligibility, coverage, and plan-specific preauthorization requirements.
• Gather and maintain accurate documentation required for authorizations, including medical records, physician notes, and supporting evidence.
• Act as a liaison between healthcare providers, patients, and insurance companies to ensure timely approvals.
• Review and address authorization denials or delays, including filing appeals and providing additional documentation when needed.
• Adhere to HIPAA regulations and ensure compliance with payer policies and procedures.
• Track and report preauthorization status, outcomes, and trends to management to identify process improvement opportunities.
