Prior Authorization Specialist ( OB Gynecology)

Roles and Responsibilities

• Review patient demographics, insurance information, medical history, and reason for service to determine eligibility for services.
  
• Verify patient eligibility by contacting health plans or third-party payors when necessary.
  
• Obtain prior authorization from health plans or third-party payors according to established guidelines.
  
• Document all interactions with patients, providers, and payors in a timely manner.
  
• Follow up on outstanding prior authorizations until resolution.
  

Desired Candidate Profile

• 2-5 years of experience in Prior Authorization (OBGYN).
  
• Strong knowledge of OB Gynecology and US Healthcare industry practices.
  
• Proficiency in Authentication, Eligibility Verification, Prior Authorization, RCM (Revenue Cycle Management), and US Healthcare regulations.