Teams at The Auctus Group

Manage strategy and lifecycle for out-of-network claims and Independent Dispute Resolution (IDR): assess eligibility, prepare persuasive submissions, track deadlines, negotiate settlements, oversee financial recovery and reconciliation, ensure procedural compliance, coach team members, and serve as primary client contact to maximize lawful reimbursements.

Manage end-to-end prior authorization and referral processes: receive, review, submit, track, and follow up on authorizations; verify insurance and patient data; use EMRs, payer portals and Availity; communicate with provider offices, payers and patients; maintain case logs, meet productivity targets, escalate issues, and assist with benefit verification and customer service.