Ensures insurance information is complete and accurate by verifying patient benefits, eligibility, policy limitations, authorization requirements, and pre-certifications.
Contacts insurance carriers and follows up with internal departments, physician offices, patients, and third-party payers to complete the pre-certification process.
Identifies patient out-of-pocket responsibility, including copay, deductible, co-insurance, coordination of benefits, replacement or supplemental coverage, termed coverage, and out-of-network status.
Collaborates with internal teams to provide account updates, resolve issues, and appeal denied authorizations.
Ensures services have prior authorizations, updates patients on preauthorization status, and coordinates peer-to-peer reviews when required.
Notifies ordering providers when authorization or certification is denied.
May coordinate scheduling for patient appointments, diagnostic and specialty appointments, tests, and procedures.
Maintains referral and insurance files, enters referrals into the system, and supports billing integrity so claims are not denied due to missing insurance information.
Runs reports to confirm timely insurance verification and authorization completion before date of service.
Responds to patient questions about insurance benefits and out-of-network coverage.
Assists physician office staff with insurance benefit questions and educates them on verification and precertification process changes.
Must have a high school diploma or equivalent.
One year of experience and relevant knowledge of revenue cycle functions, insurance eligibility, or prior authorization in a healthcare setting preferred.
Knowledge of third-party payers and prior-authorization requirements.
Understanding of basic medical terminology and procedures.
Intermediate computer skills, including Microsoft Office, email, payer websites, practice management systems, and electronic medical records.
Strong attention to detail, multitasking ability, time management, written and verbal communication skills, and the ability to work independently.
Ability to communicate effectively with patients, providers, and payers under stressful circumstances.
Fluent in English.
Experience with eClinicalWorks is a plus.
Location
Columbus, Ohio, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 week ago