Prior Authorization: Manage and process prior authorization requests for medical services and procedures, ensuring all necessary documentation is submitted accurately and promptly.
Verification: Verify insurance benefits and coverage requirements to determine the need for prior authorization and ensure compliance with payer guidelines.
Communication: Communicate with healthcare providers, insurance companies, and patients to obtain necessary information, follow up on authorization status, and resolve any issues.
Documentation: Maintain detailed records of all prior authorization requests, approvals, and denials, ensuring compliance with internal policies and payer requirements.
Follow-Up: Monitor and track the status of authorization requests, addressing any delays or issues to expedite approvals.
Compliance: Ensure adherence to relevant regulations, payer guidelines, and company policies regarding prior authorization processes.
Reporting: Generate and review reports related to prior authorization activities, identifying trends and areas for improvement.