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Precertification & Benefits Specialist (COLORADO RESIDENTS ONLY)

2 months ago

Louisville, United States Gastroenterology of the Rockies Full time

Full-Time

Non - Exempt

Pay range: $19.00 -$20.00

Reports to: Jennifer Kohlscheen

Location: REMOTE

Gastroenterology of the Rockies is a rapidly growing Gastroenterology practice in Boulder County and the greater Denver Metro area with eight office locations and five Ambulatory Surgery Centers.

As a Precertification & Benefits Specialist at Gastroenterology of the Rockies, you will play a crucial role in ensuring the seamless coordination of medical referrals, insurance authorizations, and pre-certifications. Your responsibilities will encompass verifying the accuracy and completeness of information related to patient visits, collaborating with scheduling department staff, and facilitating effective communication with doctors, patients, and peers. Through your meticulous attention to detail and expertise in insurance processes, you will contribute to the overall efficiency and excellence of our medical practice.

Key Responsibilities:

  1. Insurance Authorization and Pre-Certification:
    • Obtain and verify insurance authorizations and pre-certifications for medical procedures and services.
    • Ensure timely submission of required documentation to insurance providers.
    • Maintain a comprehensive understanding of insurance policies and requirements.
    • Preparing Cost Estimates for patients.
  2. Coordination with Scheduling Department:
    • Collaborate with scheduling department staff to gather accurate patient information prior to scheduled appointments.
    • Verify insurance details and ensure the completeness of necessary documentation.
  3. Documentation and Record-Keeping:
    • Record and maintain detailed and accurate documentation of insurance authorizations and pre-certifications in patient records.
    • Organize and file relevant paperwork for easy retrieval.
  4. Communication:
    • Communicate effectively with doctors, patients, and peers to obtain and provide necessary information.
    • Liaise with insurance companies to resolve any issues related to authorizations and pre-certifications.
  5. Compliance and Regulations:
    • Stay informed about changes in insurance regulations and policies.
    • Ensure compliance with all relevant healthcare regulations and standards.
  6. Problem Resolution:
    • Proactively identify and address any issues related to insurance authorizations or pre-certifications.
    • Work collaboratively with the team to find solutions to challenges that may arise.


Qualifications:
  • Education: High school diploma required; additional relevant certifications or coursework in healthcare administration or a related field preferred.
  • Experience: Minimum of 2 years of experience in a similar insurance specialist role within a medical practice setting.
  • Strong understanding of medical insurance processes and requirements.
  • Excellent communication and interpersonal skills.
  • Detail-oriented with the ability to manage multiple tasks efficiently.
  • Proficient in using relevant computer software and systems.