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Why You'll Love This Job

Key Responsibilities:


1. Authorization Management:

   - Obtain and verify pre-certifications or referrals for medical procedures, surgeries, and tests as required by insurance providers.

   - Collaborate with physicians, nurses, and other clinical staff to gather necessary clinical information for precertification requests.

   - Track and monitor pending authorizations and re-authorizations.


2. Communication:

   - Serve as a liaison between the medical staff, billing department, and insurance companies.

   - Communicate with insurance providers to ensure timely submission and approval of requests.

   - Notify clinical staff and patients of any issues or denials.


3. Documentation:

   - Maintain detailed records of all communications and authorization documents.

   - Update patient files with relevant pre-authorization information.

   - Ensure accurate entry of authorization details into electronic health records or other tracking systems.


4. Billing Support:

   - Assist the billing department in resolving claim denials related to lack of authorization.

   - Provide necessary documentation or clinical information to support appeals when necessary.


5. Regulatory Compliance:

   - Stay updated with changes in insurance policies and governmental regulations pertaining to pre-authorization.

   - Ensure processes and procedures are compliant with regulations and industry best practices.


6. Continuous Improvement:

   - Monitor and analyze precertification process efficiency and recommend changes for improvement.

   - Participate in training and professional development activities.




- High school diploma required; Associate’s or Bachelor’s degree in a related field preferred.

- Experience in medical billing, insurance, or a related field.

- Familiarity with medical terminology.

- Strong organizational skills and attention to detail.

- Excellent communication skills, both verbal and written.

- Proficiency with electronic health record systems and office software.

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