Authorization Specialist

Responsible for prior authorizations and reauthorization

Responsible for tracking authorization status and adding to all necessary systems 

Responsible for confirming medical necessity

Negotiates single case agreements for out of network insurance cases 

Establish and execute systems for maximizing insurance coverage and reimbursement

Coordinates with clinics and providers to ensure all necessary documentation is being tracked and logged to allow for reauthorization and continued care 

Works with outside pharmacies for Spravato authorization and coverage

Collaborates and facilitates needed changes to the plan of care/ level changes

Continuously checks medical policies for changes to medical criteria needed for services

Assist patients in enrolling into the Spravato REMS program and Spravato Savings Program, JPAP as needed

Schedule patients for their Spravato induction phase

Patient communication

Exhibit a high level of professionalism, empathy, and positivity