Prior Authorization Specialists offer a direct line of communication between insurance companies and patients. They ensure patients receive the coverage they need for treatments provided, and they help you improve the overall patient experienc
HealthVMA’s Specialists help patients receive approval from insurance companies for treatments that require pre-authorization. Our specialist handles the prior authorization submission. They ensure that correct CPT codes are used and that the status is checked early to guarantee that insurance will cover treatments for patients. Our specialists improve the patient experience and help them navigate the complex health insurance process.
Responsibilities of Prior Authorization Specialists
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Services our Specialists offer include:
Discussing treatment needs with patients, including procedures and medications
Communicate with nurses, physicians, and other healthcare staff
Work with insurance companies to acquire prior authorization approval on behalf of patients
Request and track pre-authorization on the behalf of patients
Verify patient eligibility and benefits with insurance companies
Secure pre-authorizations for treatments administered at patient visits
Communicate insurance adjustments to the healthcare team
Record documentation of communication with healthcare providers and insurance companies
Issue appeals when authorizations are denied by insurance providers
Answer questions regarding payer medical policies
Interpret patient chart documents to verify that patients meet medical policy guidelines
Verify the correct use of CPT codes for medical billing purposes
Organize, reference, and update the files of individual payers
Monitor all pending authorizations and prioritize the most urgent ones
MedCore works to seamlessly integrate specialists into your health organization to improve overall efficiency.