What are the responsibilities and job description for the Insurance Authorization and Eligibility Coordinator position at Greater Maryland Pain Management?
- This position is responsible for obtaining and completing all insurance pre-certifications and authorizations as required for various clinical procedures.
- Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.
- Maintains complete and accurate documentation in patient charts.
- Develops and maintains effective relations with insurance companies, physicians and medical office staff.
- Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.
- This position requires the ability to work with minimal supervision.
- Monitor new patient report and maintain organized list with status of pre-certification process.
- Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information.
- Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
- Verify receipt of all necessary pre-authorization documents prior to procedure
- Communicate effectively with the facility in which the procedure will be performed as needed.
- Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
- Notify primary care physician for managed care plans that require PCP authorization.
- Serve as a resource on insurance, billing and customer service for reception.
- Perform other duties or functions as assigned