Prior Authorization Specialist

Principal Duties and Responsibilities:

  • Receive requests for Medical Oncology/Hematology pre-authorizations and ensure that they are properly and closely monitored
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
  • Follow prior authorization work flow, policies and procedures
  • Collaborate with other departments to assist in obtaining pre-authorizations in a cross functional manner
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present
  • Consult with supervisor or nurse manager to obtain clearance that treatment regimen is considered a medical necessity
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
  • Manage correspondence with insurance companies, physicians, specialists and patients as required
  • Look through denials and submit appeals in a bid to get them approved from insurance companies
  • Create patients’ records and accounts and ensure that pre-authorization information is properly updated in them
  • Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation

Medical secretaries are responsible for patient reception, scheduling, telephone triage, and general business office functions.

Principal Duties and Responsibilities:

    • Managing telephone calls is the most important task. Secretaries are expected to handle multiple lines at the same time, triage calls appropriately, and “own” needed followup actions. At least 70% of calls should be resolved by the secretary without need to hand off to another staff member.
    • Check-in is the 2nd most important task. Provide patients with a welcoming, professional, flexible demeanor. Ensure key tasks such as eligibility checking, referral management, copay collection, registration updates, and communication with other staff consistently follow CRMA and office protocols.
    • Be comfortable in a multi-tasking, fast-paced environment where your priorities will constantly shift throughout the day.
    • Handle “demanding” patients and physicians with a smile and willingness to substitute your own needs to their needs, even if it makes your job harder.
    • Understand common medical terminology and workflows.
    • Process requests for referrals and prescription refills requests, online, phone, and in-person.
    • Responsible for appointment scheduling, patient registration/discharge and making referral/ancillary appointments.
    • Collects appropriate copays, deductibles and other related payments that are due at time of service.
    • Prepares daily deposit and adheres to established cash control policies and procedures as directed.
    • Answers patients questions regarding insurance and provides explanation of charges when appropriate.
    • Supports and assists all physicians and clinical staff with patient flow.
    • Using online and paper lookup tools, transcribes narrative diagnostic codes (ex. “Diabetes”) to ICD10 codes (ex. E11.9) for MD billable encounters.
    • Proficiently processes referrals and prior authorizations. Understand how referral requirements vary by insurance plan.
    • Coordinates mail processing for office to include receipt of record releases, copying of records, mailing out records and responding to other general office requests via mail.
    • Manages physician schedule by following up on patient no-shows, sending reminder cards and/or providing telephone reminders for physical exams.
    • Maintains and orders office supplies.
  • Performs other duties as assigned by Office Manager