What are the responsibilities and job description for the PreAuthorization/Medical Insurance Specialist position at South Heart Clinic?
Job title: Pre-Authorization/Insurance Specialist
Position Summary:
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.