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Prior Authorization Specialist
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- Support providers and reviewers with prior authorization requests for post-acute care services.
- Includes manually entering authorization requests into Care Management systems, following rules and algorithms embedded in the care management system to administratively approve prior authorization requests.
- May work with providers to secure discharge plans, Notice of Non-Medical Coverage, Durable medical equipment, and other home supports required for discharge planning.
- May support scheduling physician to physician calls.
- Will support appeal processes for CMS designated Quality Improvement Organization appeals including logging all appeal activities.
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