Pre-Authorization Specialist

Job Description

Job Description

Description :

The Pre-Authorization Specialist is responsible for ensuring that all medical services requiring pre-authorization are approved by insurance providers before patient appointments or treatments. This role involves working closely with healthcare providers, insurance companies, and patients to confirm that all required pre-certifications and authorizations are obtained efficiently. The specialist will play a key role in minimizing delays in patient care, reducing claim denials, and ensuring compliance with insurance policies and procedures.

Key Responsibilities :

1. Authorization and Verification :

• Obtain prior authorizations for required medical procedures, diagnostic tests, surgeries, medications, and treatments.
• Verify patient insurance coverage and eligibility for scheduled services.
• Submit necessary documentation and clinical information to insurance companies to facilitate approval of services.

2. Communication and Coordination :

3. Documentation and Tracking :

4. Insurance and Denial Management :

5. Compliance and Policy Adherence :

Requirements : Qualifications :

Work Environment :

Compensation and Benefits :