Case Manager/Prior Auth-Specialist

Job Description

SUMMARY:

Under supervision of the Practice Administrator, the Case Manager/PA- Specialist is responsible for coordinating the specialty outpatient care and treatment of patients through the process of prior authorization, pre-certifications, patient assistance and insurance referrals.  

ESSENTIAL DUTIES AND RESPONSIBILITIES:

*Include the following. Other duties may be assigned.*

• Obtain insurance referrals for patient care.
• Pre-certify and schedule patients for infusions and injections administered at an outpatient infusion center.
• Obtaining authorizations for medications.
• Give instructions and/or explain processes regarding insurance coverage.
• Obtain and submit necessary documentation, files, and reports needed for insurance approval.
• Assist in arranging patient assistance for medications.
• Able to perform nursing duties, if needed, to maintain the flow of the clinic.
• Abide by the rules and regulations as set forth by the State of Tennessee.

EDUCATION AND/OR EXPERIENCE:

Graduation from a standard high school or General Education Degree (GED) equivalent with successful completion of a patient care course such as CMA/RMA.  LPN is preferred.   Two or three years related experience and/or training in a medical office with a background knowledge of insurance; or equivalent combination of education and experience.

High school diploma or equivalent.  Medical billing experience highly preferred but not required.  

OTHER SKILLS AND ABILITIES:

Ability to establish and maintain an effective working relationship with faculty members, students, residents, staff, patients, and other third parties.  Ability to operate computers, keyboard, and printers.  Ability to operate phone system.  Ability to concentrate on the situation at hand and listen effectively.  Ability to organize tasks, work as a team member and/or independently.  Knowledge of ICD-10 and CPT coding.

EOE/AA/M/F/Disability/Vet

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