- Initiate pre-authorization requests to payers for procedures requiring approval.
- Communicate with payers, patients, physician offices, and clinical staff.
- Monitor appropriateness and medical necessity for authorization.
- Collect patient demographic and insurance coverage information.
- Advise patients of financial obligations and collect payments.
- Perform quality assurance audits and report findings to leadership.
- Manage scheduling changes due to lack of authorization.
- Ensure documentation of copays, deductibles, and insurance requirements.
- Maintain relationships with clinical partners and utilization review departments.
- Educate providers and clinical staff on prior authorization processes.
Microsoft Office