Case Study Of Medicare

Decent Essays
• Process Prior Authorizations utilizing ICD-9 codes, CPT/4 and HPCPCS coding. • Review patient chart notes and doctor’s notes referencing plan guidelines in order to approve prior authorizations. • Submit prior authorization requests to Pharmacist for final review/determination. • Assist Quality Assurance department with monitoring of new hires. • Provide guidance on areas of improvement and create individual performance improvement plan for struggling employees. • Acquire extensive knowledge of Medicare Part D procedures and CMS guidelines and requirements in order to efficiently submit, process and review Medicare claims electronically. • Prepare reports and input data into excel spreadsheets for review. • Update databases ensuring
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