Pre Authorization Rep

Job Summary

You will ensure a smooth and efficient pre-admission and pre-authorization process for all patients, safeguarding necessary financial clearance before services are rendered. You will also serve as a key point of contact, coordinating with physicians' offices, insurance providers, and hospital departments to facilitate seamless patient access to care.

Responsibilities

• Accurately gather and verify patient demographic and insurance information
• Obtain necessary pre-certifications and authorizations from insurance companies
• Communicate financial responsibilities to patients
• Serve as a key point of contact, coordinating with physicians' offices, insurance providers, and hospital departments
• Prevent claim denials and ensure financial integrity
• Utilize payer website to obtain precertification electronically
• Review electronic orders to ensure precert CPT matches what is ordered by the physician
• Interact with schedulers and notify them when peer-to-peer calls are necessary
• Interact with coding or clinical staff to ensure that medical necessity requirements are met
• Stay up to date on insurance policies and criteria that must be met

Requirements

• High School Graduate or GED, upon hire
• 1 year experience with pre-certification at a medical clinic/facility preferred