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MP
Medical Practice
Insurance Authorization and Pre-Certification Specialist
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Job Description
Insurance Authorization and Pre-Certification Specialist Medical Practice - 2.0 Odenton, MD Job Details Full-time $21 - $24 an hour 9 days ago Qualifications Insurance verification Managed care Medical insurance coverage verification Patient service High school diploma or GED Pre-authorization review for utilization management Policy verification in claims processing Health record tracking Health insurance referral requirements Managing patient records Medical terminology Full Job Description 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