Responsible for timely verification of benefits and prior authorizations for physicians and physical therapists.
- Updates and maintains patient demographics as needed
- Verifies insurance eligibility from provider schedules, real-time systems, and before scheduled appointments
- Reviews credentialing and contract information for accuracy
- Obtains referrals from primary care providers when needed
- Secures eligibility and prior authorizations for DME, surgeries, outside testing, and physical therapy
- Coordinates with Front Office, Medical Records, Medical Assistants, and Account Representatives
- Maintains insurance authorization and referral files
- Covers team members as needed and works overtime when required
- Participates in professional development and staff meetings
- Maintains patient confidentiality in accordance with HIPAA and company policy
- Performs additional duties as assigned
Requirements & Qualifications
High school diploma or GED and 2 years of relevant experience.
- Pre-verification and prior authorization experience in a medical office setting preferred
- Knowledge of basic medical terminology, coding, eligibility, and prior authorization processes
- Strong computer and phone skills, including multi-line phone systems
- Excellent grammar and spelling skills
- Ability to build effective working relationships with staff, patients, and vendors
- Ability to read, analyze, and interpret medical and business information
- Ability to manage multiple tasks efficiently in a high-volume environment
- Understanding of healthcare regulatory and compliance policies, including HIPAA
- Ability to work flexible hours, including some evenings and weekends
- Spanish language skills preferred
Location
Albuquerque, New Mexico, US
Employment Type
Not specified
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago