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enter and review referrals and prior authorization requests, including researching and obtaining additional information as necessary or returning to sender, per standard policies and procedures
review claims for appropriate billing and correct payment
identify and route claims for advanced or clinical review
assist in providing coordinated care
Requirements:
at least one year of experience in a health-related setting, including knowledge of insurance plan benefits, regulations, care coordination, and authorization functions
knowledge of medical terminology and coding
Nice to have:
excellent communication skills including interviewing, active listening, negotiation, persuasion, and conflict resolution