Verification Specialist - Specialty
About The Position
The Verification Specialist - Specialty reviews, processes, and follows prior authorization requests through to completion for services, excluding PBM authorizations. The role collaborates with healthcare providers, insurance companies, patients, Intake Specialists, and the Clinical Review Team to facilitate authorization or pre-determination of services. It includes reviewing clinical documentation, verifying that required supporting materials are complete, navigating payer requirements, and tracking requests and follow-ups to help avoid delays in care while maintaining compliance and confidentiality.
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.
- Ability to maintain confidentiality and comply with HIPAA and applicable federal and state requirements for protected health information.
Nice To Haves
- Knowledge of medical terminology.
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 obtaining authorizations for specialty and complicated therapies.
- Review each prior authorization request and ensure required supporting documentation and forms are complete.
- Process prior authorizations by fax, computer, or phone, as required by payers.
- Maintain organized processes for documenting and tracking prior authorization requests.
- Follow up on and troubleshoot pending prior authorizations in a timely manner.
- Document prior 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 prevent missed prior authorization requests.
- Communicate to a supervisor when assistance is needed, including with system functions or training.
- Safeguard patient and company confidentiality and follow HIPAA and applicable federal and state requirements for PHI and EPHI.
- 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 changes in the work environment.
- 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
