RN Prior Authorization

Role Summary

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RN Prior Authorization

Prior Authorization RN is responsible to obtain prior authorization for medications and/or procedures when required by the patient’s health insurance company. The RN routinely communicates and collaborates with patients, insurance companies, other departments, and healthcare providers.

• Hours: Full-time/40 hours per week
• Required: RN; ADN

Responsibilities

Assists with other tasks to support patients or team members., Assists with other tasks to support patients or team members., Documents results of authorization approval/denial in the patient chart., Maintains up-to-date knowledge of new medications/procedures and diagnoses for which the treatment is effective., Notifies the ordering healthcare provider and patient if authorization is denied and works to help resolve the denial in an effort to gain approval., Notifies the ordering healthcare provider and patient if authorization is denied and works to help resolve the denial in an effort to gain approval., Obtains current patient demographics and insurance benefits from Registration., Obtains current patient demographics and insurance benefits from Registration., Requests authorization after medications / procedures have been provided when needed., Requests authorization after medications / procedures have been provided when needed., Responsible for contacting patients' insurance companies to obtain prior authorization (if required) for medications and/or procedures ordered by the healthcare provider., Serves as a customer service representative and liaison among patient, insurance company, and medical staff., Serves as a customer service representative and liaison among patient, insurance company, and medical staff., Works closely with the healthcare provider's office nurse to ensure proper authorization is obtained. Collects insurance benefit information, sends supporting medical records, and provides benefits of medication and/or procedures ordered., Works closely with the healthcare provider's office nurse to ensure proper authorization is obtained. Collects insurance benefit information, sends supporting medical records, and provides benefits of medication and/or procedures ordered.

Requirements

ADN (Required)RN-Registered Nurse - Illinois Department of Financial and Professional Regulation

• Estimated Compensation Range
• $27.68 - $42.90
• Pay based on experience