The Job
Major Duties and Accountabilities:
Handles inbound telephone and written inquiries from providers and staff regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
Provides information to patients, participants, pharmacists and doctors regarding participant’s benefit coverage.
Facilitates resolution of prior authorization issues and pro-actively addresses researches and resolves issues while maintaining accurate and complete documentation of all inquiries.
Obtains prior authorization for non-formulary medications.
Assists the patients in obtaining appointments with specialists and acquiring special medical procedures.
Assists in obtaining appointments for hospital follow-ups.
Maintains ongoing tracking and appropriate documentation on referrals.
Communicates professionally and respectfully to Insurance companies acting as a patient advocate and representing the clinic professionally.
Communicates with clinical staff on any issues or need for further follow up.
Contacts the patients regarding any pending referrals, and or diagnostic testing.
Faithfully documents and retains all communication regarding the referral/authorization process.
Works collaboratively with other associates and managers to ensure that best practices are shared.
Maintains knowledge of resource materials such as medical dictionary, policy/procedure manual, employee handbooks, and organizational chart.
Complies with policy and procedure manual of the clinic.
Provides calm, reassuring atmosphere and communicates effectively with patients, staff, physicians, and other guests.
Performs other related duties as assigned.
Performs procedures according to the LMC policies and procedures as noted on skills check list/competency.
Other jobs as assigned.
0 - 2 Years
2 Openings
1.3 - 2.3 Lac/Yr
Face-to-Face interview
