Medical Receptionist/Prior-authorization Specialist
Experience: 2 - 5 years
➢Providing an exceptional customer service experience, responding to and resolving customer service inquiries, and identifying the topic and type of assistance the customer needs. ➢Research complex issues across multiple databases and work with support resources to resolve customers and/or partner with others to resolve escalated issues. Documenting multiple platforms and routing requests. ➢Locating and establishing contact with in network providers and setting appointments for members. ➢Explained benefits and coverage, status of claims and resolving billing inquiries. ➢Delivered complex information in a positive manner. Assisting with filing complaints and grievances. ➢Issue Management Advocate: Helping leadership to delegate follow up commitments and ensure timelines are met. ➢Served as a point of contact for leadership, providing daily updates.
Experience: 1 - 2 years
> Respond to incoming calls from provider offices, hospitals, and facilities. > Review CPT and diagnosis codes to determine coverage under the plan. > Determine whether prior authorization is required and if predetermination is advisable. > Submit prior authorization requests. > Monitor the status of prior authorizations. > Verify the network status of providers.
Experience: 2 - 5 years
Experience: 2 - 5 years
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