Precertification & Insurance Verification Team Member
Full Time
Rolla, MO 65401
Posted
Job description
General Summary
The Insurance Verification/Prior Authorization Team Member is responsible for verifying patient eligibility, determining benefits, and to obtain insurance prior authorization prior to patient’s exam date and time.
Essential Duties and Responsibilities
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Obtains or assists in obtaining prior authorization/precertification from insurance payers for surgical, laboratory, and diagnostic imaging procedures scheduled to be performed.
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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.
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Makes and receives calls on the status of authorizations and verifies benefits over the phone and/or via insurance payer websites.
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Confirms member Plan eligibility and benefits prior to processing a request for pre-certification. Utilizes clinical knowledge, clinical resources or clinical policy as required.
Job Qualifications
Education
High school diploma or equivalent required. Graduate of a Registered Medical Assistant or Licensed Practice Nurse program preferred.
Work Experience
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.
Certification/License
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. Communicates well both verbally and in writing, creates accurate and punctual reports, shares information and ideas with others, has good listening skills. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.
Working Conditions
Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.
Location: Phelps Health · Precertification and Insurance Verification
Schedule: Full-time, Day shift, 8-4
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