Referral Coordinator

Prior Authorization SpecialistPrepare and submit prior authorization requests to insurance companies, including necessary medical documentation, diagnosis codes, and treatment plans.Analyze medical records to determine if a requested service or medication aligns with medical necessity guidelines and insurance coverage.Contact healthcare providers to gather additional information or clarify details regarding requested services for prior authorization.Monitor the status of pending prior authorization requests and follow up with insurance companies to obtain timely approvals.Explain the prior authorization process to patients, including potential delays and necessary documentation.Maintain accurate records of all prior authorization requests, including patient information, insurance details, and approval status.Collaborate with billing staff to identify and resolve potential billing issues related to prior authorization.Accurately verify patient insurance information, including eligibility, benefits, and coverage details.