This position maintains quality services and efficient operations by obtaining prior authorizations for admissions, infusions, medications, imaging, echocardiograms, EEGs, physical therapy and serial casting, nuclear medicine, etc. for the Pediatric Multidisciplinary Neuroscience patient population.

Principal Accountabilities:
1.    Verify patient benefits (in-network and out-of-network) and pre-certification requirements for requested services.
2.    Obtain authorization for hospital admissions - urgent and treatment-related.
3.    Update insurance companies with any changes/updates as needed.
4.    Acquire pre-certification for radiology services - complete all requests and any radiology scan scheduled outside of Atlantic Health System.
5.    Confirm authorization requirements for outpatient drugs.
6.    Outpatient infusions authorizations as needed.
7.    Specialty laboratory services pre-certifications
8.    Obtain authorizations for specialty pharmacy medications.
9.    Follow up with insurance companies for all denials and appeals.
10.    Coordinate peer-to-peer or doctor-to-doctor insurance calls.
11.    Respond to requests for patient summaries/treatment information from insurance companies, outpatient laboratories and pharmacies.