Senior Prior Authorization Specialist
CurrentI work with patients, clinics, internal sales representatives and insurance representatives to secure approvals for surgery authorizations. To do this, I must review clinical data next to unique insurance policies, effectively communicate what is needed to secure approvals and support patients and clinics as they work to accomplish this. I'm also proficient at appealing denials, following various insurance rules and regulations up to external medical review/independent medical review (Maximus for example) to fully advocate for patients. This job requires proficiency in Microsoft programs, exceptional communication skills, customer service and critical thinking/persistence with roadblocks that present themselves in the health Insurance process.