Job Description

Job Description

Job Description

Job Description

• Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
• Insurance Verification determine if Participating in net work or out of Network- confirmed Members Benefits for services being rendered
• Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
• Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
• Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
• Coordinates with Providers and Members regarding authorization requests and/or activities
• Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
• Reviews all authorization requests for accuracy and prioritizing based on urgency
• Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
• Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
• Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Performs other duties and special projects, as assigned

Experience Requirement: 

• Experience (Preferred)

Preferred Qualifications:

• Knowledge of CPT and ICD9/ICD10 coding/ Clinical.
• Understanding of insurance plans, i.e. HMO, POS, PPO
• Knowledge of Excel and Word
• Excellent Organizational Skills; Attention to Detail
• Exceptional Communication Skills
• Working Knowledge of Insurance Company Operations and Procedures
• Excellent customer service skills
• Ability to prioritize work in a fast-paced environment
• Computer skills
• Appeals/Retro active request skills
• Sending Specialty Prescription when needed 
• MRI Authorization Utilization Management 
• Knowledge of Manufacture Co-Pay Assistance Program/Foundation.  

Benefits:

• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• 401k
• 401k matching
• Flexible Spending Account
• Aflac
• Optum Transit
• Paid time off
• Parental Leave

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