Job Title:

Insurance Pre-Certification Specialist

This position is:

Full Time

Position Location:

Lake Charles, LA

GENERAL SUMMARY OF DUTIES:

The purpose of this position is to gather benefits and eligibility information from insurance companies, to obtain eligibility verification for patients, and to relay benefit information and an estimated cost of treatment.

ESSENTIAL FUNCTIONS:

1. Responsible for assuring appropriate insurance verification, prior approvals, and all authorization requirements are obtained prior to the patient's arrival for surgery or procedure.
2. Communicate with physicians, mid-level providers, and clinical staff as needed to obtain and understand clinical documentation requirements
3. Provide required clinical documentation to payers via phone, faxed forms, and/or website
4. Contact Referring and other external providers as needed
5. Clearly document authorization approvals and denials in Practice Management systems including authorization numbers and associated codes, dates, and other relevant data.

KNOWLEDGE:

1. Basic knowledge of managed care.
2. Basic computer knowledge, typing and 10-key skills needed
3. Previous knowledge of insurance is helpful.
4. Previous medical terminology helpful.

EDUCATION:

High school diploma or equivalent

EXPERIENCE:

1. Experience with obtaining prior authorizations is highly preferred.
2. Moderate level of computer skills including EMR (electronic Medical record), Practice Management system, basic office applications including Outlook, Word, Excel and use of the internet.
3. Customer service experience; preferably in healthcare related environment.