Patient partner vs prior authorization specialist

Differences between patient partner and prior authorization specialist duties and responsibilities

Patient partner example responsibilities.

• Communicate with insurance companies on a continuous basis to ensure hospital reimbursement and attain authorization for home and rehabilitation services.
• Verify and confirm CPT codes for correct sleep study, verify that the referral and scripts are sign.
• Collaborate with health care team (s) provide concurrent review and identify ICD-9 and CPT billing codes.
• Listen carefully for key concerns of patients and respond accordingly.
• Provide assistance in directing and escorting non-emergency patients to other designations throughout the hospital setting.
• Comply with HIPPA and OSHA protocol guidelines and demonstrate a professional level of confidentiality in regard to all patient/facility affairs
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Prior authorization specialist example responsibilities.

• Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
• Manage quality communication, patient support and service representation with patients and providers to establish equipment/procedures statuses and expedite orders.
• Work with staff to ensure proper CPT codes are submit on authorization request.
• Demonstrate compassion while obtaining patient demographics and personal health information.
• Register patients into the emergency department or outpatients for surgery or procedures.
• Register patients' demographics and insurance information; execute daily outpatient and surgery reports.
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