- Run benefit eligibility checks to confirm coverage, cost-share, and authorization requirements before care begins.
- Manage medical prior authorization requests, renewals, and extensions end to end.
- Prepare and submit PA documentation and escalate stalled or denied authorizations.
- Follow up with provider offices to secure unsigned documents and orders.
- Coordinate clinical staffing and medication shipping with partners.
- Answer and route inbound calls from providers, pharmacies, and members.
- Maintain accurate member records in compliance with HIPAA standards.
- Design and document repeatable workflows for administrative processes.
CRMEHR