Prior Authorization Specialist

6 days ago

dombivli, India beBeePrior Full time

Job OverviewSedona Management Solutions is a trusted partner for cutting-edge technical solutions. We deliver innovative and tailored solutions to address unique business needs.This position involves reviewing patient medical records, communicating with healthcare providers and insurance companies, and ensuring timely care for patients.Key ResponsibilitiesPatient Record Review: Determine prior authorization necessity based on patient medical records.Communication: Gather information from healthcare providers, patients, and insurance companies to submit requests.Documentation: Maintain accurate records of all authorization requests, approvals, and denials in compliance with HIPAA regulations.Follow-up: Resolve issues during the approval process and follow up on pending authorizations.Insurance Updates: Stay updated on changes in insurance policies, managed care requirements, and medical coding practices (ICD-10).Collaboration: Work with medical office staff to ensure seamless patient care and efficient processing of authorizations.Patient Education: Educate patients on the prior authorization process and necessary steps.Authorization Processing: Process sleep authorizations for studies in-lab and home sleep studies, consultations, appeals, and oral appliance referrals.RequirementsDetail-Oriented: Quick learner with excellent customer service skills and ability to work accurately with high volumes of data.Communication Skills: Ability to effectively communicate with healthcare providers, patients, and insurance companies.Organizational Skills: Ability to maintain accurate documentation and stay organized in a fast-paced environment.Adaptability: Ability to adapt to changing priorities and deadlines.

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