RedValley the coolest and fastest-growing company is seeking an experienced Prior authorization specialist to join our new medical team. You will be responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribing and triaging patient calls to physicians, and coordinating patient appointments/orders.

What You'll Do

• Review chart documentation to ensure the patient meets medical policy guidelines
• Prioritize incoming authorization requests according to the urgency
• Obtain authorization via the payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines