Copying Machines, Fax Machines, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Insurance, Interpersonal Skills, Medicaid, Medical Terminology, Medicare, Multitasking, Nursing Management, Office Equipment, Patient Confidentiality, Preferred Provider Organization (PPO), Regulations
Job title: Pre-Authorization/Insurance Specialist
Position Summary:
Responsible for insurance verification precertification, preauthorization’s.
Duties and Responsibilities include but are not limited to:
- Assists with the Verification of insurance benefits, eligibility.
- Precertification/preauthorization of indicated studies.
- Ensure that all precertification are done in advance, before the patient is
scheduled for the studies indicated.
- Submits required notes to insure carriers for authorization purpose
- Ensure documents (authorization/data/numbers) are entered into EHR system.
- Alerts the physicians for none covered services
- Communicates with the physicians and Nursing Supervisor with non-supportive
documentation.
- Communicates with all insurance carriers: Medicare, Medicaid, Commercial, PPO,
network benefits, etc.
- Seeks advice and guidance from certified coder with regards to coding guidelines.
- Performs related work as required.
- Practice and adhere to HIPPA regulations.
Qualifications and Specifications:
- Education-High School Diploma some college preferred
- Knowledge of basic office procedures.
- Knowledge of basic office equipment including copier, fax and computer
- Ability to speak clearly and concisely.
- Skills in dealing with interpersonal issues and patient relations.
- Ability to handle multiple priorities at once with minimal supervision.
- Knowledge of Medical Terminology.
- Ability to maintain confidentiality of patient information.
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