Precertification Representative - Marshall Internal Medicine

Job Responsibilities

Utilizes the necessary electronic and manual systems to identify and capture source documentation needed for the coding of ordered procedures, tests, surgeries, etc.

Answers phone calls and/or inquiries from insurance carriers or other parties to assist in the prior authorization for scheduled procedures as necessary.

Performs the precertification process for scheduled procedures as necessary, including communication of any balances due to the patient.

Communicates and appropriately documents the details of the procedure authorization. Includes information such as approved CPT code, diagnosis code, and Date of Service range to entity performing the procedure and documents details of authorization in the patient medical record per approved protocols.

Provides backup to clinics as needed.

Performs other duties as assigned or requested.

Education

Completion of a certification program such as Medical Assistant, Nurse Assistant, or equivalent required. Experience: One year of billing or clinical experience in a health care organization is required.

Internal applicants must call HR at ext. 11653 to determine eligibility before applying.