Pre-authorization position. - page 2

I only have an Associate's degree.. but many years of experience in many areas. I will be started a pre-authorization position on Monday. I would appreciate any advice on how I can learn this skill . I understand I will be... Read More

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    Hey everybody, I just want to add, I worked for Aetna, Inc for 10+ years. When the RN's were unable to approve procedures ( breast reductions, gastric bypass surgeries, abdominoplasties, uppp's, hernia repairs), based on our criteria, they they were refered on to the medical director for review. We had to send all of the info we gathered, (photo's, documented failed diet plans, sleep study, lack of tolerance of cpap, etc) The job requires total organization in order to meet deadlines and turn around times. I totally enjoyed it. Good luck!!

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    Quote from RN In FL
    Hey everybody, I just want to add, I worked for Aetna, Inc for 10+ years. When the RN's were unable to approve procedures ( breast reductions, gastric bypass surgeries, abdominoplasties, uppp's, hernia repairs), based on our criteria, they they were refered on to the medical director for review. We had to send all of the info we gathered, (photo's, documented failed diet plans, sleep study, lack of tolerance of cpap, etc) The job requires total organization in order to meet deadlines and turn around times. I totally enjoyed it. Good luck!!
    Yes, although we have some criteria in place that allows me to authorize breast reductions, gastric bypasses (for those funds still allowing that procedure) and all hernias without sending out to our medical reviewers...the uppp's..no, those always go....also those cheesy dental appliances-when the patients don't want to wear the cpap machines and they read on the internet (usually on web site called something like "I hate cpap.com"..) about these things..I have to get all of that going and send that out and prove they can not wear the cpap...the funds will usually pay for one or the other not both...as far as the requests for the "iffy" stuff...we sure as heck tell them when they call in that it' is better to make the DOS TBA...as we can not control our medical reviewer and the turn around times...usually pretty fast...but better to be safe than sorry...also for the blephs...

    My "favorite" call is to take in a case for something like a uppp and the surgery is the next day.....I'm like, REALLY? Especially with really weak clinical...you know what I mean... ..um, "she snores"..ok, what else...that's it....yes, good luck.............................
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    Hi- Been there done that- So far, do you enjoy your job doing pre-certs for a large HMO? I'm very curious because I'm also interested in getting my foot in the door in the insurance field. Can I schedule an informational interview with you @ your convenience for 15 minutes? I was a research nurse for 7 years @ Emory University & got laid-off back in 2009 & I'm currently working with Visiting Angels. I am looking for an administrative position. I don't want to be working in patient care any more because it was never a good fit for me. Just let me know.-Thank you!-Lisa
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    Hi nulife4good- Did you enjoy your work @ HealthNet and Anthem Blue Cross? I am a RN with a variety of nursing roles & I was a research nurse for 7 years @ Emory University & got laid-off back in 2009. I am currently working with Visiting Angels doing home care assessments. I am interested in getting my foot in the door in the insurance field. Can I schedule an Informational Interview with you for 15 minutes of your time @ your convenience? Would like to ask you some questions & get your feedback & recommendations. Just let my know.-Thank You-Lisa
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    Hi diva rn- Sounds like you have a lot of experience working in pre-cert with insurance companies. I am a RN with a variety of nursing roles & my last good gig was as a research nurse for 7 years & then I got laid-off back in 2009. Currently I'm working with Visiting Angels doing home visits on a part-time basis. I am interested in getting my foot in the door in the insurance field. Can we schedule an Informational Interview for 15 minutes of your time @ your convenience? I would really appreciate getting your feedback & recommendations. Just let me know. -Thank you-Lisa


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