JOB SUMMARY
This position is primarily responsible for pre-certifying procedures and surgeries ordered by physicians. This position is also responsible for coordinating with patients, insurance companies, hospitals, primary care physicians and/or any other medical representatives by performing the following duties.
DUTIES AND ESSENTIAL JOB FUNCTIONS
- Core duties and responsibilities include the following. Other duties may be assigned.
- Processes surgery schedulers packets for benefits according to protocol.
- Contacts patient insurance carrier to verify benefit information and eligibility.
- Faxes Requestfor Authorizations and/or any other forms insurances request, as well as all clinicalinformation on to insurance carrier.
- Annotates on chart patient's policy limits and/or any co-pays, etc. in E.M.R. (Electronic Medical Record). Annotate authorization number on surgery schedule
- Prepares Letter of Medical Necessity and/or paperwork as required by patient insurance to begin appeal s process, as needed.
- Submits insurance verification forms to supplier of products on patients using prosthetics.
- Sets up Peer to Peer review between physician and insurance carrier if prior authorization has been denied.
- Advises physician and begin appeals process when procedure is exclusion to patient's plan.
- Obtains authorization for administration and specialized medication s -authorization obtained through Medication Intake Department or through Specialty Pharmacy
- Maintainsconstant communication with billing department in the event of insurance error or changes to patient insurance in order to file or re-file claim.
- Performs other duties as assigned.
Other functions and Responsibilities
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
COMPETENCIES
- Patient & Customer Focus
- Ethical Conduct
- Flexibility
- Initiative
- Personal Effectiveness/Credibility
- Stress Management/Composure
QUALIFICATIONS
Required
- 6 months experience as a medical front desk with durable expertise of coding.
- 6 months related experience and/or training, or comparable blend of education and learning and experience.
- Willingness to attend continuing education courses at the request of the employer.
- Strong medical terminology
- Knowledge of insurances and respective requirements