High School diploma or equivalent required. One year of experience in a similar position in a medical office preferred. Knowledge of medical terminology and medical office procedures preferred. Knowledge of third party payers and pre-authorization requirements preferred. Basic computer skills required. Must be able to work as a member of a team along with effective communication skills. Job Duties Include:
• Contacts insurance carriers after verifying information to secure benefit coverage, policy
limitations, pre-certification, etc. for customers.
• Conducts follow-up calls as necessary to physician offices, patients, and third party payers
to complete pre-certification process.
• Contacts relevant internal staff to update status, coordinate resolution/correction of issues,
sends records to insurance companies and determines whether a denied authorization
should be appealed.
• Educates internal and external customers regarding referral/prior authorization
requirements, eligibility guidelines, documentation requirements, and insurance procedures.
• Maintains reference materials as they pertain to insurance carrier procedures.
• Maintains referral tracking logs and ensures that they are kept up to date.
• Maintains patient confidentiality and abides by all HIPPA guidelines.
• Schedules outside testing and appointments
• Schedules appointments, procedures, and testing as needed.
• Responsible for compliance with Organizational Integrity through raising questions and
promptly reporting actual or potential wrongdoing.