Employment Type:

Full time

Shift:

Description:

GENERAL SUMMARY AND PURPOSE:

Performs insurance verification and pre-authorization on all clinical procedures, diagnostics and operative services requiring prior authorization from the insurance plan. Verify patient’s insurance benefit and create payment plan based on patient deductible and co-insurance responsibility. Communicates authorization and patient financial responsibility to clinic.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• High School Diploma or equivalent required.
• Education, training or experience as a medical coder, medical billing, Medical Assistant, Insurance or Surgical Coordinator or other relevant clinical background required.
• Medical terminology and anatomy required.
• Working knowledge of CPT and ICD coding.
• Demonstrated ability of critical thinking skills to efficiently organize work and maintain a high level of accuracy and productivity.
• Working knowledge and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations) preferred.
• Knowledge of payer regulations and reimbursement.
• Ability to work independently with minimal supervision; as well as part of a team working with others to solve problems, improves work flow, assure back-up, and achieve an enjoyable work atmosphere.
• Proficiency in computer skills which include Microsoft Office and Medical Practice Management system, such as NextGen.

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Organizational Mission, Core Values, and Vision in behaviors, practices, policies and decisions.
• Process information daily from clinic regarding clinical procedures, diagnostics and operative services that are ordered and/or scheduled.
• Assigns CPT and ICD codes as necessary for procedure to obtain authorization.
• Contacts insurance payer for insurance benefits and prior authorization based on payer requirements.
• Accurately documents authorization in patient financial record.
• Communicates authorization and patient financial responsibility to clinic, within 48 hours.  Exception: expect immediate turn around for urgent/emergent procedures.
• Appropriately prioritizes workload and maintains productivity.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.