Maintains, confirms and secures referrals. authorization, or pre-certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements.

Responsibilities:

• Ensures Information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third party payer requirements/on-line eligibility systems.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the pre-certification process.
• Collaborates with intersal departments to provide account status updates, coordinate the resolution of issues, and appeal denied authorizations.
• Educates patients, staff and providers regarding referral and authonzation requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Ensures all services have prior authorizations and updates patients on their preauthorization status. Coordinates peer to peer review if required by insurance.
• Notifies patient accounts staff/patients of insurance coverage lapses, and self-pay patient status. May notify ordering providers if authorization/certification is denied.
• May coordinate scheduling of patient appointments, diagnostic and/or specialty appointments, tests and/or procedures.
• Maintains Fles for referral and insurance information, and enters referrals into the system, Maintains knowledge of, and reference materials of the following Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre- authorization and a list of current accepted insurance plans.

Education Required:

• High School Graduate.

Experience Required.

• Typically requires 1 year of experience in providing customer service that includes experiences in patient accounts, third-party payer plans, accounts receivable/collection processes, and medical clinic processes and workflow.

Knowledge, Skills & Abilities Required:

• Knowledge of third-party payers and pre-authorization requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic
• mail, physician practice management, and electronic medical records systems.
• Strong analytical, prioritization and organizational skills.
• Ability to work independently with minimal supervision and to manage multiple priorities.
• Exceptional communication and interpersonal skills with a high degree of diplomacy and tact. Ability to effectively communicate with a variety of people under stressful circumstances.

Physical Requirements and Working Conditions:

• Exposed to a normal medical office environment.
• Sits the majority of the workday.
• Operates all equipment necessary to perform the job.

Job Types: Full-time, Contract

Pay: $28.00 - $31.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off

Weekly day range:

• Monday to Friday

Application Question(s):

• Please provide your email address.
• Do you have experience in providing customer service that includes experiences in patient accounts and medical clinic processes and workflow?
• Do you have experience of third-party payers and pre-authorization requirements ?
• Do you have understanding of basic human anatomy ?
• Do you experience of the procedures for application in the patient referral/pre-certification/authorization processes?

Education:

• High school or equivalent (Preferred)

Experience:

• Insurance: 1 year (Preferred)
• Patient Accounts: 1 year (Preferred)
• Collection processes: 1 year (Preferred)
• Accounts receivable: 1 year (Preferred)
• Medical terminology: 1 year (Preferred)
• EPIC System: 1 year (Preferred)
• UHC (United Healthcare) portal: 1 year (Preferred)

Work Location: In person