- Verifies insurance/managed care plans for eligibility for all of the insurance plans listed in the patient account and documents information in TxM and Athena.
- Uses Athena to confirm eligibility and/or contacts the payer directly and documents the outcome in the patient account.
- Obtain prior authorizations for each infusion plan listed on each day in a timely manner to as not to delay treatment for patients.
- Will pre-certify all patient infusions and injections by confirming their insurance/managed care plan eligibility in addition to confirming whether prior authorization for visits and treatments are necessary.
- Advises staff of any insurance plan updates.
- Authorize specialty pharmacy drugs for patients and maintains an accounting through the PBM log system.
- High School graduate or equivalent
- Prior medical office experience required
- Prior Authorization Certified Specialist (PACS) preferred
- Knowledge of insurance company/managed care organization constraints related to the retinal practice's office procedures, visits, testing and drug therapy.
- prior authorization experience of one year strongly preferred
- Must have a high level of customer service, interpersonal and organizational skills
- Must be able to multi-task and handle a fast-paced busy environment
- Strong working knowledge of basic computer programs, and good typing skills
- Ability to plan, prioritize, and complete delegated tasks in a reasonable span of time
- Ability to work independently and as a member of a team
- This position may require cross-coverage of other positions, as needed, and therefore a measure of flexibility to respond adequately to changing demands is required
Authorization Specialist - Wethersfield, United States - Summit Health
Description
Description
On Site Position - Wethersfield, CT
Required Qualifications:
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