Precert/Ins Verification Team Member | Full-Time, Day Shift

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri. We’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, join the Phelps Health family.

About the role

The Insurance Verification/Prior Authorization Team Member is responsible for verifying patient eligibility, determining benefits, and obtaining insurance prior authorization before the patient’s exam date and time.

Responsibilities

• Obtains or assists in obtaining prior authorization/precertification from insurance payers for surgical, laboratory, and diagnostic imaging procedures scheduled to be performed.
• Processes multiple patient prior authorization/precertification requests at any given time in an efficient and accurate manner.
• Documents prior authorization/precertification decisions following clinical policy in clinical software.
• Makes and receives calls on the status of authorizations and verifies benefits over the phone and/or via insurance payer websites.
• Confirms member Plan eligibility and benefits prior to processing a request for pre-certification.
• Utilizes clinical knowledge, clinical resources, or clinical policy as required.

Requirements

• High school diploma or equivalent required.
• Graduate of a Registered Medical Assistant or Licensed Practice Nurse program preferred.
• Minimum 1 year of clinical experience in a health care organization required.
• Experience in insurance verification and prior authorization process preferred.
• Knowledge of medical terminology and CPT & ICD-9/10 codes preferred.

Mental/Physical Requirements

• Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions.
• Normal mental concentration with repetitive operations for a long period of time.
• Strong verbal and written communication skills; ability to create accurate and punctual reports, share information and ideas with others, and demonstrate good listening skills.
• Ability to stand, walk, sit, and reach.

Working Conditions

• Standard office conditions with more than average noise.
• Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.