PHRN - Clinical Authorization Specialist

Qualifications

• At least 1 year of relevant BPO experience as a Clinical Authorization Specialist
• PHRN licensed
• Willing to report onsite and on a night shift schedule

Responsibilities

• Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency to the patient.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
• Respond to clinical questions regarding payer medical policy guidelines