working with various insurance vendors for financial viability of company by insuring that approvals are in place before services as needed
Pros: Management would work with associates on a last minute as needed for family, or other personal request not shown on department schedule, lunches and breaks were great, coworkers were willing to help, managment would meet with you regarding work related issues, managment supported some departmental suggestion from representatives.
Cons: management was not always supportive of personal growth within department, there was some favoritism per others complaint.
A typical day at work would start out with daily connection, such as department updates, promotions / leaves and Q/A following. After this representatives would follow up on previous days accounts and work according to department protocol. Inpatients, outpatients, surgical procedures. Working with insurance companies such as Cigna, Anthem, Unitedhealthcare and Molina to obtain prior authorizations consisted of finding appropriate diagnosis and procedure codes to obtain approval. If care review department needed more medical history on a specific patient to overturn a denial representatives would contact the patient by phone for more medical information not contained in medical notes recieved from the physicians office. This information would be called into the contact person at the insurance company or faxed per their request. On occasion representative would contact the patient or clinic informing them of a denial or authorization.