Prior Authorization & Verification Specialist

OVP Health Care•Huntington, WV

About The Position

This role is responsible for managing the prior authorization process for medications. This includes reviewing patient medical history, communicating with various stakeholders (prescribers, insurance companies, patients), submitting requests, monitoring their status, and updating patient records. The specialist will also be responsible for tracking referrals and maintaining confidentiality of patient information. A key aspect of the role is to foster a positive and professional work environment.

Requirements

Knowledge of third-party payers and prior authorization requirements.
Understanding of basic medical terminology and medications.
Proficient use of office equipment, such as copier, fax machine, phones, etc.
Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical record systems.
Strong time management skills.
Ability to work independently with minimal supervision.
Ability to manage multiple priorities.
High school diploma or equivalent.

Nice To Haves

One (1) year of experience and relevant knowledge of insurance eligibility or prior authorization in a healthcare setting.
Certified pharmacy technician, certified medical assistant, or licensed practical nurse.

Responsibilities

Reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations.
Reviewing patient medical history to identify supporting documentation in the patient chart relevant to the medication.
Communicating professionally with prescribers, practice support staff, patients, and representatives of insurance companies (oral and written).
Contacting insurance companies via appropriate method to obtain prior authorization.
Updating patient medical records with approval or declination information.
Following up with ordering physicians regarding the status of prior authorizations.
Efficiently tracking pending authorizations for multiple offices/prescribers.
Creating a positive, professional, service-oriented work environment.
Maintaining confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations.
Reviewing, submitting, planning, and tracking of referrals made by clinic providers.
Adhering to all Federal, State, and Local laws and regulations as well as policies.