A direct channel of communication between insurance companies and patients is provided by prior authorization specialists. Additionally to ensuring patients have the coverage they require for the treatments they receive, they assist you in enhancing the general patient experience.

What Exactly is Prior Authorization?

Prior authorization, according to HealthCare.gov, is when a health plan must consent before you receive a service or fill a prescription for it to be covered by your plan. Healthcare providers and insurance companies must work together to make sure that a patient’s plan covers the work that is being done. Otherwise, you need a prior authorization specialist for your practice, and MedCore can help with this.

Prior Authorization Specialist: What Is It?

Moreover, patients who require treatment that calls for insurance carrier pre-authorization are helped by a prior authorization specialist. To determine the patient’s prescription needs, they conduct interviews¬†and communicate with insurance providers and nurse managers to obtain prior authorization approval. Prior authorization specialists frequently work for insurance companies and the billing departments of medical clinics. Prior approval experts could eventually become pharmacists with more study.

Additionally, the submission of the previous authorization forms is handled by the experts at MedCore. To ensure that insurance will pay for patients’ treatments, they make sure the proper CPT codes are utilized and that the status is reviewed early. The specialists at MedCore enhance the patient experience and guide them through the difficult health insurance process.

Also, the specialists at MedCore must have a variety of skills, including excellent oral and written communication skills, remarkable customer service skills, organization, effective time management, and a thorough understanding of laws and official medical language.

Prior Authorization Specialists’ Job¬†Responsibilities

Our specialists provide the following services:

  • Interacting with patients to discuss treatment requirements, including procedures and medications
  • Converse with nurses, doctors, and other medical personnel.
  • Work with insurance providers to request prior authorization on patients’ behalf.
  • On behalf of the patient, request and monitor pre-authorization.
  • Check the patient’s benefits and eligibility with the insurance companies.
  • Obtain pre-approvals securely for treatments given during patient visits.
  • Describe changes in insurance to the medical staff.
  • Keep track of correspondence with healthcare providers and insurance firms.
  • When insurance companies reject authorizations, file appeals.
  • Respond to inquiries about payer medical policies.
  • To ensure that patients adhere to medical policy rules, interpret patient chart documents.
  • Check that CPT codes are being used correctly when billing for medical services.
  • Organize, list, and keep up with each payer’s own file.
  • Monitor all outstanding authorizations and focus on the most important ones.

MedCore aims to seamlessly integrate specialists into your healthcare system to increase overall success.

Looking to Add a Prior Authorization Specialist to Your Practice?

MedCore Solutions can help your practice tackle staffing shortages and challenges with medical billing, as well as bring necessary staff members to your team. They are an industry leader in streamlined medical billing and administrative services. The prior authorization specialists at MedCore are extremely knowledgable and can help your practice overcome any billing or insurance related issues at hand.MedCore tailors solutions to the needs of each medical practice so providers can focus on what matters most: taking care of their patients. Learn more at https://medcoresolutions.com/.


HealthCare.gov. Prior authorization Рglossary.  (2023). Retrieved from https://www.healthcare.gov/glossary/prior-authorization/#:~:text=Approval%20from%20a%20health%20plan,be%20covered%20by%20your%20plan.

Indeed. What does a prior authorization specialist do? (2023). Retrieved from https://www.indeed.com/career/prior-authorization-specialist

MedCore Solutions. Prior authorization specialists. (2023, April 25). Retrieved from https://medcoresolutions.com/prior-authorization-specialists/