Job Description
Key Responsibilities Authorization Management Obtain and verify prior authorizations for services, treatments, and procedures. Review patient insurance eligibility and benefits to ensure coverage requirements are met. Submit authorization requests accurately and timely through payer portals, fax, or phone. Track authorization status and follow up with insurance companies as needed. Maintain accurate documentation of authorization approvals, denials, and expiration dates. Communicate authorization updates to clinical and scheduling teams. Denial Management Review denied or rejected claims to identify root causes and trends. Research payer policies and determine appropriate corrective actions. Prepare and submit appeals with supporting documentation within payer deadlines. Work collaboratively with billing, coding, and clinical departments to resolve claim issues. Monitor denial reports and maintain denial logs for tracking and reporting purposes. Escalate unresolved or recurring denial ...