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Pre Certification Rep

4 months ago

Newnan, United States Surgery Partners Full time
Description

Georgia Bone and Joint is seeking an insurance verification and prior authorization representative to join our Clinic's Precertification Department. This person will communicate with insurance companies, patients, and healthcare staff to ensure we receive accurate coverage details, provide necessary information for authorization and continued visits, resolve discrepancies, create, and maintain digital records, all required to help and ensure proper claim filings. This role requires accuracy and attention to detail, knowledge of insurance terms and policies, and effective communication skills to be successful.

Duties and responsibilities include:

  • Accurately verify the patient's insurance benefits for authorization for visits using online information or by calling insurance companies to obtain necessary and accurate information.
  • Create documentation to communicate the information to the providers and help track approved visits.
  • Monitor schedule daily for coverage changes and update patient records with accurate insurance information.
  • Review and interpret insurance policies and benefits.
  • Works with insurance companies, branches, intake personnel and others as required to collect, update, and manage needed information.
  • Responsible for obtaining, tracking, communicating, and extending authorizations as needed per insurance company requirements promptly.
  • Verify receipt of all necessary pre-authorization documents prior to therapy and maintain insurance authorizations for current patients.
  • Collaborates with medical billing team to ensure accurate claims submissionand assist in researching claim denials.
  • Ensures that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system and EMR.
  • Maintain confidentiality of patient information in compliance with HIPAA regulations.
  • Must be well organized, a self-starter and able to prioritize tasks based on greatest need daily, without constant supervision.
  • Must be comfortable with computers, MS Word and Excel.
  • Perform other related duties as assigned by management.
Qualifications
Behaviors Dedicated - Devoted to a task or purpose with loyalty or integrity
Team Player - Works well as a member of a group
Detail Oriented - Capable of carrying out a given task with all details necessary to get the task done well