Job Description

The Pre-Authorization Certification Representative is responsible for obtaining pre-authorizations for outpatient and office diagnostic services for an extremely busy specialty practice. Candidates must be a strong team player and have excellent communication, organization and follow-up skills with the ability to multi-task. Working efficiently to ensure timely filing of claims and collaborating on initiatives to enhance the financial and operational performance of the practice are key goals. Previous pre-authorization experience in cardiology is preferred.

Responsibilities include, but are not limited to:

Primary responsibility will be obtaining pre-authorizations for inpatient, outpatient and office diagnostic services for an extremely busy specialty practice. Working with insurance companies to initiate, follow-up and complete the pre-authorizations using telephone and insurance company web sites. Working with clinical staff for assistance when clinical information is needed. Utilize insurance websites to accurately process authorizations, upload medical record documentation and follow up on pending authorizations. Knowledge of insurance company requirements for pre-authorizations preferable. Cardiology testing knowledge preferable. Answers incoming calls from patients to schedule testing or update insurance information. Also assist Business Office by answering all incoming calls and assisting with patient's account questions and taking payments. Verify insurance eligibility via practice management system, payer portal and/or by phone. Confidentially maintain and update patient account information in compliance with HIPAA guidelines. Maintain accurate documentation of all interactions and actions.
Knowledge, Skills and Abilities required:

Knowledge of insurance eligibility and benefits (deductible, copay, co-insurance). Knowledge of and experience using payer resources for referrals and authorizations. Familiarity with EMR, medical records, reading and understanding medical records. Positive, driven attitude with a willingness to go the extra mile to help patients and to help the office achieve financial and operational success. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers, supervisors and hospital staff. Former medical assistant experience a plus. Excellent communication skills, oral and written. High School graduate or general education degree.
Job Type: Full-time

Benefits:

401(k) Dental insurance Employee assistance program Health insurance Life insurance Paid time off Retirement plan Vision insurance
Experience:

Medical office or Pre-authorization: 2 years (Preferred)
Work Location: In person