Summary of Role
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are completed before inpatient, outpatient, and ancillary services are delivered. Works closely with healthcare providers, patients, and insurance companies to secure required approvals and resolve coverage issues.
Requirements & Qualifications
Qualifications
- High school diploma or equivalent
- Minimum 2 years of experience in medical insurance verification, pre-authorization, or a related role
- Experience in an orthopedic or surgical setting preferred
- Proficiency with electronic health records (EHR) and insurance verification software
- Experience with EPIC and Microsoft Office preferred
- Strong verbal, nonverbal, and written communication skills
- Solid understanding of insurance policies, pre-certification, and authorization processes
Physical and Mental Demands
- Ability to clearly explain the pre-authorization process, required documentation, and expected timelines to patients and healthcare providers
- Strong communication and collaboration skills when working with billing departments and hospital staff
- Basic arithmetic and the ability to interpret insurance plans, statements, and financial data
- Ability to use spreadsheet software such as Microsoft Excel to organize and analyze data
- Good judgment and decision-making skills to identify and resolve issues efficiently
- Ability to accurately use medical and insurance terminology and navigate EHR and insurance verification systems
Location
Wisconsin, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago