Job Title

Essential Duties and Responsibilities include the following:

• Understand and execute the principles of Prior Authorization to facilitate the right care at the right time in the right setting.
• Perform all assistant and coordinator job functions.
• Able to solve complex prior authorization questions and issues.
• Effectively handle all incoming provider calls including the most challenging provider offices.
• Identified trends with provider offices and interfaces with those provider offices.
• Request Network Management training or on site visit to provider offices needing reinforcement.
• Identify issues that need to be escalated to a lead or supervisor.
• Identify opportunities for improvement and make recommendations for change.
• Process requests from Access Express that are pended or reprocess approved or denied auths and package properly for review and resolution.
• Check e...