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Insurance Authorization Specialist M-F 830-5
3 months ago
WOOSTER COMMUNITY HOSPITAL POSITION DESCRIPTION
Insurance Precertification Representative
PRIMARY ROLE:
Safeguards hospital revenue for inpatient admissions and outpatient services that necessitate precertification. Verifies that all necessary notifications for admissions have been executed. Ensures that all planned outpatient services requiring prior authorization/precertification possess the correct and suitable approvals before services are provided.
REPORTS TO: The Director and Manager of Patient Access
ESSENTIAL QUALIFICATIONS:
- Experience in a medical office or hospital environment working with third-party payers to secure authorization for hospital services.
- Proficient understanding of medical terminology.
- Excellent organizational abilities and proven capacity to work autonomously.
- Current computer skills or familiarity with Meditech.
- Effective interpersonal and verbal communication skills.
- No written disciplinary actions in the past year.
PREFERRED QUALIFICATIONS:
- Two years of prior experience in a medical office or hospital setting.
- Knowledge of medical billing and/or coding.
- Post-secondary education in medical office administration.
- Ability to utilize the internet and other technologies effectively.
KEY RESPONSIBILITIES:
- Receives notifications for services/testing scheduled at the hospital.
- Efficiently navigates payer websites to confirm insurance benefits and obtain necessary precertifications according to payer guidelines.
- Contacts third-party payers as needed to request authorization for ordered services.
- Inputs verification details into the Meditech system and physician office EMR.
- Accesses the physician's EMR to gather clinical information related to the ordered service, including prior testing results (e.g., lab values, imaging results).
- Initiates precertification notifications for all inpatient admissions.
- Confirms completion of all required precertifications for outpatient procedures.
- Communicates precertification denials to the physician's office and scheduling department.
- Maintains a professional rapport with physicians and their office staff.
- Keeps an organized record of precertification tasks.
- Effectively communicates with other departments all necessary information to finalize the precertification process.
- Successfully operates within a team-oriented work environment.
M-F 830-5
M-F 830-5
