Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriate system. Your knowledge of insurance carriers and specific plan details will make you a valuable resource to patients, providers, and coworkers! Knowledge of medical codes and medical terminology required.
Duties and Responsibilities:
Obtains pre-authorizations/pre-certification per payer requirements for services rendered and ensures authorization information is documented in the appropriately in the system
Verifies physician orders are accurate
Ability to understand and communicate insurance co-pays, deductibles, co-insurances, and out of pocket expenses for point of service collections
Communication is maintained with providers, clinical staff, and patient in relationship to authorization status
Works and assists with the billing department in researching and resolving rejected, incorrectly paid and denied claims as requested
Helps to maintain a professional atmosphere for patients, family members and staff
Remains current with insurance requirements for pre-authorization and provides education within the departments and clinics on changes
Keep management informed of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding
High school degree or equivalent
Knowledge of CPT, HCPCS, and ICD-10 codes highly preferred
Medical terminology required
Ability to prioritize and perform multiple tasks with many interruptions
EMR experience required; MEDENT preferred
Requires prolonged sitting and/or standing; primarily using phone and computer
Position requires manual and finger dexterity and hand-eye coordination
Involves standing, sitting, and walking
Team member will occasionally be asked to lift and carry items weighing up to 10 pounds; normal visual acuity and hearing are required
