Authorization Verifier

JOB SUMMARY:    
Responsible for gathering all information required  on the authorization, completing authorization form, and submission of form  to insurance company.  Responsible for all follow up phone calls of the authorization and documentation into CPR+ of authorization status.
 
SCOPE OF ROLE AND RESPONSIBILITES:
Oversee and participation in all aspects of drug authorizations.
 
ESSENTIAL FUNCTIONS:

• Verify the correct authorization form and plan to submit authorization through.

• Gather all necessary information from Dr. office to complete authorization form.

• Responsible for submission of authorization form  to the Insurance plan.

• Notifying appropriate staff of approved/denied medications.

• Process/reverse online claims as required.

• Responsible for maintaining required spreadsheets.

• Responsible for all follow up phone calls to the insurance company for status of authorization.

• Responsible for all documentation of authorization statuses into CPR+ progress notes.

• Update Sales Staff with pertinent information.

 
ADDITIONAL RESPONSIBILITIES:
 

• Perform other duties as assigned by supervisor.

 
QUALIFICATIONS & ABILITIES:

• High school graduate, with a minimum of 1 year medical insurance verification, benefits and eligibility investigation experience.

• Good computer skills.

• Knowledge of medical terminology.

• Good communication skills.                                        

• Ability to work cooperatively.

• Professional Image.

• Ability to adhere to C.A.R.T. principles:

Ø              Competence
Ø              Accountability
Ø              Respect
Ø              Trust
 
REQUIRED EDUCATION/TRAINING AND/OR PROFESSIONAL EXPERIENCE:
 

• High School Diploma or equivalency.

EXPECTED PROFESSIONAL COMPETENCIES:

• N/A

LICENSURE/CERTIFICATION REQUIREMENTS:

• N/A

CONTINUING EDUCATION:

• N/A

 
DIRECT REPORT:       
Reports Verification Manager.