BPN Insurance Verification and Authorization Specialist

Reviews all procedures, referrals and prescription medications with the applicable insurance policies to ensure all the payer's required guidelines are met prior to the service being rendered to ensure maximum reimbursement. Responsible for communication with all offices and appropriate personnel regarding the authorization of services. Responsible for any required retro-authorizations as well as communicating any peer-to-peer review requirements between the payer and the ordering provider or assigned advanced physician provider.

PRINCIPAL JOB FUNCTIONS :

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• Commits to the mission, vision, beliefs of Bryan Health and consistently demonstrates our core values.

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4. Maintains productivity and quality standards as defined through the organizational and departmental goals and objectives.

5. Serves as work resource and liaison to internal and external hospital departments, physicians' offices and patients for pre-service authorizations.

6. Submits patients supporting medical records and necessary information to payer authorization representatives for prior authorizations via fax, phone or online portals.

7. Submits prior-authorization request for prescription medications using online portals, fax or phone along with supporting medical records.

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13. Maintains accurate payer website information and logins to ensure most current information is obtained for the necessary authorization requirements.

14. Communicates with Patient Financial Services regarding denials and appeals / reconsideration letters received from payers.

15. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

16. Participates in meetings, committees and department projects as assigned.

17. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "

EDUCATION AND EXPERIENCE :

High School diploma and one (1) year relevant work experience in a medical clinic, health care, insurance industry, pharmacy or medical billing office required. Certified Medical Assistant or Medication Aide, coding certificate or other clinical background preferred. Must be 19 years of age to witness legal consents.