Key Responsibilities:


- Review case and insurance coverage information to customize the prior authorization request to the insurance company or physician’s office.

- Navigate through payer portals to initiate/obtain prior authorization status.

- Provide insurance company representatives with an overview of the services being submitted for prior authorization.

- Answer questions regarding... the reimbursement process and direct testing specific and treatment questions.

- Complete LOMN (letter of medical necessity) form based on client or insurance requirements and fax to the ordering physician’s office for completion.

- Follow up with the insurance company or physician’s office as needed.

- Meet benefit investigation process standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the task.

- Participate in team meetings by sharing the details of cases worked.

- Comply with all applicable SOPs.

- Meet or exceed productivity and quality KPI goals.

- Perform other duties as assigned.



Education/Experience:


- High School diploma or GED

- Previous health insurance billing experience

- Working knowledge of medical terminology

- Proficient and attentive to details

- Excellent written and verbal communication skills

- High attention to detail

- Ability to maintain confidentiality

- Proficient in using Microsoft Excel and Word

- Ability to multitask, establish priorities, and work independently



 
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