BMS Insurance Precert Representative

Job Description

Job Title: BMS Insurance Precertification Representative Department: BMS Administration

Reports to: Assigned Manager/Director FLSA Status: Non-Exempt

Job Summary:

Responsible for the verification of patients' benefits and precertification requirements that are performed for services. Ensures all proper notifications of services occurred. Ensures all scheduled and non-scheduled services requiring prior authorization/precertification have the correct and appropriate authorizations prior to services being rendered.

Duties/Responsibilities:

• Works with clinical and clerical staff and patients to efficiently process insurance precertification and prior authorizations
• Communicates denials and follow up to the office/appropriate department
• Communicates effectively with other departments all information necessary to complete the precertification process
• Functions successfully in a team-oriented work environment
• Responsible to use a quiet and professional voice in an open work area in compliance with HIPAA standards.
• Communicates lapse in Coverage to appropriate parties
• Communicates effectively with department all information necessary to complete the precertification process for treatment
• Enters verification and authorization information in Meditech system, to be shared with the customers, regarding their benefits, patient responsibility, and approvals
• Calls patients to communicate insurance determination of services and assists to continue with services at the customer's request or reschedule appointments as needed.
• Effectively navigates payer websites to verify insurance benefits and obtain necessary pre-certs per payer guidelines
• Review of payers' newsletters to learn of upcoming changes and understand the need for changes at our facility.
• Utilizes the ARM Authorization Referral Management for tracking numbers of remaining visits. Proactively collaborating with therapists for additional authorized visits.
• Responsible for first level appeal of any denials that result from precertification errors
• Reviews the Electronic Medical Record (EMR) to obtain prior testing for services
• Verifies completion of all needed pre-certs for outpatient procedures, Inpatient, ER VA notification
• Keeps an organized record of precertification work lists
• Communicates denials to patients if services cannot be authorized. Able to provide cost estimates to patients so they can determine whether to proceed with receiving the services without insurance coverage.
• Displays a positive attitude. Treats others with honesty and respect. Speaks positively in all internal or external customer interactions.
• Assesses customer satisfaction when interacting with patients and other non-patient customers and uses appropriate chain of command for unresolved issues or problems.
• Uses face-to-face resolutions with crucial conversations to intervene with patients or staff in situations where customer needs have not been met to determine a positive, mutually agreeable outcome.
• Always uses courteous telephone techniques when speaking to the physician's office, patients, co-workers, and hospital departments.
• Establishes and maintains effective relationships with clinical areas and staff.
• Demonstrates effective oral/written communication between all department areas

Required Skills/Abilities:

Proficient in Medical Terminology

Demonstrated effective interpersonal and oral communications skills

Proficient in Microsoft Office suite


Demonstrated organizational skills and ability to work independently.

Education and Experience:

Education:

High School Diploma or GED

Experience:

At least 2 years working in a physician's office or hospital with third party payers to obtain authorization for services, with experience with electronic medical records (EMR)

Proficient in medical terminology

Proficient in Microsoft Office suite


Prior medical billing and/or coding knowledge and Post High School education in medical office skills preferred

Meditech EMR experience highly preferred

Effective Date: 11/19/2025

Revision Date(s):

Approved: TMMYERS