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Pre Authorization Specialist
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- The Pre-Authorization Specialist is a member of the Pre-Authorization Department who is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient and ancillary services.
- The Pre-Authorization Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record.
- Successfully works with payers via electronic/telephonic and/or fax communications.
- Responsible for verification and investigation of pre-certification, predetermination, and referral requirements for services.
- Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
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