Pre-Cert Coordinator - Clinic

Essential Functions

• Verifies benefits and eligibility to process patient benefits in a timely manner; including necessary prior authorizations.
• Calculates patient due portions based on insurance verification.
• Communicates with patient on their payment expectations.
• Schedules appointments as needed.
• Understands insurance carriers and their medical policies.
• Processes all clinic referrals and authorizations for ancillary services including but not limited to: Radiology, Pain Management, and Neurology.
• Reviews payment records for patients and third parties, ensuring fees are collected properly.
• Answers phone calls and returning voicemails in a timely manner.
• Checks and resolves assigned tasks in Electronic Health Record.
• Adheres to compliance of OAC policies and standard operating procedures.
• Sets the standard for the team with excellent patient care.
• Is available to other team members to offer assistance, information, and directions.
• Maintains open and positive lines of communication, and functionality.
• Understands and adheres to HIPAA laws and regulations in compliance and patient confidentiality.

Knowledge Performance Requirements

• Knowledge of Commercial Insurance and Medical Policies.
• Knowledge of Medicare, Medicaid, and third party vendors.
• Knowledge of payer referrals, authorizations, and pre-determinations.
• Proficient in Microsoft Office.

Skills

• Excellent customer service skills.
• Analytical and problem solving skills.

Qualifications

• 1-2 years of experience with medical insurance, benefits verification, prior authorizations, medical billing, or a related field preferred.
• Associate’s or Bachelor’s degree in healthcare, business, finance, other related field, or equivalent experience, a plus.
• EHR system experience.

Physical Requirements

• Ability to work effectively in a fast-paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel Requirements

• Travel may be required.

Scheduled Working Hours

• Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays.
• Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties

• Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job.
• Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment

• Operates standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.