General Summary, Principal Duties & Responsibilities:

Completes insurance prior authorizations/pre-certifications for medications, testing/procedures.

Works under the supervision of the Office Manager.

This position is responsible for obtaining insurance pre-certifications and prior-authorizations for medications and testing/procedures.

-Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.

-Request, track and obtain prior authorization approval from insurance carriers 

-Follow up on outstanding requests. Clearly document all communications and contact with the insurance carrier, patients, providers, and staff.

-Notify patient/pharmacy/servicing provider of approval

-Relay denial information to providers; complete and track appeals as instructed.

-Demonstrate and apply knowledge of medical terminology

-Communicate any insurance changes or trends among team.

-Take messages accurately and relay to appropriate personnel.

-Maintain a level of productivity suitable for the department.

-Answering phones - courteously and professionally.

-Update insurance information 

-Answer general patient questions.

Knowledge, Skills & Abilities Required:

Required:

• Must have excellent verbal and written communication skills. Effective customer relation skills, ability to organize and interpret data. 
• Requires good judgment, and ability to problem solve. 
• Ability to work effectively independently and in a team environment.
• Able to use a personal computer and related software.
• Excellent organizational skills and patience required.
• Ability to type correspondences, memos, and letters.
• Clinical knowledge and experience, in addition to medical and pharmacy terminology. This is a clerical role not providing direct patient care; certification/license not required. 
• Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame.
• Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed.
• Demonstrates adaptability to expanded roles.
• Adheres to clinic’s policies and procedures.

Education:

-HS diploma or GED.

-Medical terminology coursework helpful.