Verification Specialist - Specialty
About The Position
The Verification Specialist - Specialty reviews, processes, and follows prior authorization requests through completion for services, excluding PBM authorizations. The position collaborates with intake and clinical review teams and supports authorization of specialty and complicated therapies. It reviews requests and supporting documentation, submits authorizations through payer-required channels, and tracks pending requests, follow-ups, denials, and authorization details in patient records. The role also supports timely care by helping prevent missed authorization requests and communicating issues to the appropriate teams. It requires safeguarding confidential company and patient information in accordance with HIPAA and applicable federal and state laws, while providing courteous service to clients, patients, and payers.
Requirements
- High school diploma or GED.
- Excellent organizational skills.
- Ability to work independently, stay on task, and assist coworkers as needed.
- Ability to maintain accurate and detailed charts and notes in the company system.
- Excellent verbal and written communication skills.
- Ability to work under stressful conditions in a fast-paced environment.
- Self-starter who takes initiative to learn.
Nice To Haves
- Knowledge of medical terminology is preferred but not required.
Responsibilities
- Review, process, and follow prior authorization requirements through completion for services, excluding PBM authorizations.
- Coordinate with Intake Specialists and the Clinical Review Team to identify and process requests requiring prior authorization or pre-determination.
- Assist the Clinical Review Team with authorizations for specialty and complicated therapies.
- Review prior authorization requests and ensure supporting documentation and forms are complete.
- Process prior authorizations by fax, computer, or phone, as required by payers.
- Maintain organized processes for documenting, tracking, following up on, and troubleshooting prior authorization requests.
- Document authorizations, expiration dates, and other required information in patient records.
- Communicate prior authorization denials to the Clinical Review Team and Admission Specialists and ensure prompt follow-up.
- Review newly accepted patients for a second check to help prevent missed authorization requests.
- Notify a supervisor when assistance is needed, including with system functions or training.
- Safeguard patient and company confidentiality and comply with HIPAA and applicable federal and state privacy laws.
- Provide exceptional customer service to clients, patients, and payers.
- Maintain a positive, courteous, respectful, and helpful attitude toward clients, coworkers, and management.
- Adhere to company policies and procedures and adapt to frequent workplace changes.
- Perform other tasks and duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
