PreAuthorization/Medical Insurance Specialist

Pre-Authorization/Insurance Specialist

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.