Prior Authorization Clerk

Working in medical call center to handle requests for authorizations. Coordinating cases for precertification and prior authorization review

Daily Responsibilities:  

• Managing incoming calls or incoming post services claims work

• ID and data entry of referral requests into the UM system in accordance with the plan certificate

• Respond to telephone and written inquiries from clients, providers and in house departments.

• Determine contract and benefit eligibility

• Provide authorization for inpatient admission, outpatient precertification, prior authorization and post services requests.