Billing - Specialty Medicine
Maximus Partners, LLC, Phila, PA, United States
Precertification Specialist who will focus on specialty medications. The main purpose of this role is to obtain insurance prior authorizations so patients can start and continue their prescribed treatments without delay.
Main Responsibilities:
Submit prior authorizations for specialty medications
Understand Manual Process (Not automated) Must – See through to end of process
Work directly with insurance companies through payer portals (variety of portals)
Gather clinical documentation from providers when insurance requires it
Track authorizations from submission to approval or denial
Follow up on denials and manage appeals
Communicate authorization status to providers and patients
Enroll patients in copay assistance programs when applicable
Maintain accurate records and basic reporting
Insurance/Benefits knowledge
Billing/A/R background
Main Responsibilities:
Submit prior authorizations for specialty medications
Understand Manual Process (Not automated) Must – See through to end of process
Work directly with insurance companies through payer portals (variety of portals)
Gather clinical documentation from providers when insurance requires it
Track authorizations from submission to approval or denial
Follow up on denials and manage appeals
Communicate authorization status to providers and patients
Enroll patients in copay assistance programs when applicable
Maintain accurate records and basic reporting
Insurance/Benefits knowledge
Billing/A/R background