Prior Authorization Specialists

Prior Authorization Specialists offer a direct line of communication between insurance companies and patients. They ensure patients receive the coverage they need for treatments provided, and they help you improve the overall patient experience.

MedCore’s Specialists help patients receive approval from insurance companies for treatments that require pre-authorization. Our specialist handles the prior authorization submission. They ensure that correct CPT codes are used and that the status is checked early to guarantee that insurance will cover treatments for patients. MedCore’s specialists improve the patient experience and help them navigate the complex health insurance process.

Prior Authorization Specialist Skills

Skills our Specialists possess include:

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Responsibilities of Prior Authorization Specialists

Services our Specialists offer include:

  • Discussing treatment needs with patients, including procedures and medications
  • Communicate with nurses, physicians, and other healthcare staff
  • Work with insurance companies to acquire prior authorization approval on behalf of patients
  • Request and track pre-authorization on the behalf of patients
  • Verify patient eligibility and benefits with insurance companies
  • Secure pre-authorizations for treatments administered at patient visits
  • Communicate insurance adjustments to the healthcare team
  • Record documentation of communication with healthcare providers and insurance companies
  • Issue appeals when authorizations are denied by insurance providers
  • Answer questions regarding payer medical policies
  • Interpret patient chart documents to verify that patients meet medical policy guidelines
  • Verify the correct use of CPT codes for medical billing purposes
  • Organize, reference, and update the files of individual payers
  • Monitor all pending authorizations and prioritize the most urgent ones

MedCore works to seamlessly integrate specialists into your health organization to improve overall efficiency.