Obtains pre-authorizations and pre-certifications according to payer requirements for services rendered and documents authorization information in the appropriate system. The role serves as a key resource to patients, providers, and coworkers through knowledge of insurance carriers, plan details, and medical terminology.
Responsibilities include:
- Obtaining pre-authorizations/pre-certifications for services rendered
- Verifying physician orders for accuracy
- Explaining co-pays, deductibles, co-insurance, and out-of-pocket expenses for point-of-service collections
- Communicating authorization status with providers, clinical staff, and patients
- Assisting the billing department with researching and resolving rejected, incorrectly paid, and denied claims
- Maintaining a professional atmosphere for patients, family members, and staff
- Staying current on insurance requirements and educating departments and clinics on process changes
- Keeping management informed about authorization process changes, insurance policies, billing requirements, and rejection or denial codes related to claim processing and coding
Requirements & Qualifications
High school diploma or equivalent.
Required or preferred qualifications:
- Knowledge of CPT, HCPCS, and ICD-10 codes is highly preferred
- Medical terminology required
- Ability to prioritize and manage multiple tasks with frequent interruptions
- EMR experience required; MEDENT preferred
Location
New York, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago
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