Job Description

Overview

Responsible for insurance verification, pre-certification, pre-authorizations and pre-determination for CT & Vascular procedures in the ARH System. The position requires a thorough understanding of office-management software and a good working knowledge of medical/surgical clinical procedures, claims procedures and insurance company regulations. Requires accuracy, attention to detail and ability to communicate well with physicians, staff, patients and provider representatives of insurance companies.

Special Instructions

Busy Orthopedic Clinic

Responsibilities

• Assesses, obtains, verifies and documents patient’s insurance coverage and benefits to determine coverage for procedures.
• Achieve the goals and to meet the denial rates to ensure minimum loss of revenue and maximum payment for services.
• Obtains pre-certification and/or preauthorization prior to date of procedure with the goal of staying a minimum of one week ahead
• Occasionally communicates with patients their benefits and potential out of pocket exposure for procedures ordered by physicians
• Accurately documents in computer all referral pre-certification and other information relevant to a patient’s insurance coverage and financial arrangements
• Acts as a resource to staff regarding pre-certification processes
• Performs other duties as assigned.

Qualifications

Minimum Education

Associates degree or equivalent experience preferred.

Minimum Work Experience

One-year minimum experience working with insurance pre-certification, billing and coding preferred.

Required Skills, Knowledge, and Abilities

Knowledge of current coding for CPT/ICD9/HCPS.

Excellent organizational, communication, and medical terminology.