Why You'll Love This Job
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.
- 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.
- 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.