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Benefits/Precertification Specialist
4 months ago
Job Type
Full-time
Description
Summary: The Benefits and Eligibility/Precertification Specialist is responsible for reviewing insurance benefits and eligibility for all scheduled patients and obtains required authorization for services performed by CDHA providers.
Essential Duties and Responsibilities•
Work schedule/tasks/messages to manage the following:
Verification of active insurance coverage
Initiate the Utilization Review process.
Obtain necessary prior authorizations for services and procedures.
File necessary appeals/reconsiderations for denied cases.
Communicate expected patient responsibility to CDHA staff and/or patient.
Keeps abreast of changes in Medicare, Medicaid, and insurance providers regarding pre-certification procedures.
Working knowledge of CPT codes, ICD9 codes, ICD10 codes and Medical Terminology
Upholds the CDHA mission by actively contributing to the achievement of organizational goals, supporting leadership, promoting unity and teamwork for the benefit of patients.
Demonstrates a commitment to quality of care.
Maintains a clear focus on patient safety in every interaction with every patient.
Actively participate in workplace improvement to maintain a patient service excellence environment.
Adheres to all industry standards related to infection control, patient confidentiality, and regulatory and accrediting body's requirements (i.e., HIPAA, OSHA, and AAAHC).
•Follow and comply with all safety policies.
•Additional duties as assigned.
Requirements
Education/ and or Experience:
•High School Diploma or GED. •1-2 years of experience in a medical office setting required. •Knowledge of medical office and or medical billing software •Must be able to successfully interpret Explanation of Benefits and Electronic Remittance Advice statements. •Excellent organizational, problem solving, and critical thinking skills are required. •Must be a team player and able to work with various departments throughout the organization. •The ability to maintain confidentiality is required. •Must be able to communicate effectively both verbally and in writing.
•Participates in performance improvement activities.
•Is actively committed to meeting / exceeding employee expectations / satisfaction in the performance of job functions.
•Retains all accreditations, licensures, and designations in good standing.
•Maintains compliance with all laws and applicable regulatory requirements. Acts promptly to comply with required changes.
