Insurance Verification/Prior Authorization Specialist
Obstetrix Medical Group
LOS GATOS, CA
01.2025 - Current
- Maintained files for referral and insurance information, entering referrals into system.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Notified ordering providers of denied authorizations.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Utilized medical coding knowledge to accurately process and document authorization requests.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Developed and implemented process improvements to enhance efficiency and accuracy of prior authorization workflows.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Input claim, prior authorization, and other important medical data into system.
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Evaluated patient eligibility and benefits for requested procedures and medications.
- Interpreted benefit language in order to determine covered services under each plan type.
- Maintained positive working relationship with fellow staff and management.
