Job Description

Pre-Cert Coordinator

Job Summary:

Working as a part of the Clinic Financial Coordinator team, this employee will be responsible for reviewing eligibility and benefits, obtaining required referrals and/or authorization, communicating patient financial responsibility and performing all financial coordination functions for ancillary services.

Additionally, this team member works closely with providers and other clinic staff to ensure that services are approved prior to the patient’s arrival.

Essential Functions:

• Verifies benefits and eligibility to process patient benefits in a timely manner; including necessary prior authorizations.
• Calculates patient due portions based on insurance verification.
• Communicates with patient on their payment expectations.
• Schedules appointments as needed.
• Understands insurance carriers and their medical policies.
• Processes all clinic referrals and authorizations for ancillary services including but not limited to: Radiology, Pain Management, and Neurology.
• Reviews payment records for patients and third parties, ensuring fees are collected properly.
• Answers phone calls and returning voicemails in a timely manner.
• Checks and resolves assigned tasks in Electronic Health Record.
• Sets the standard for the team with excellent patient care.
• Is available to other team members to offer assistance, information, and directions.
• Maintains open and positive lines of communication, and functionality.
• Understands and adheres to HIPAA laws and regulations in compliance and patient confidentiality.

Performance Requirements:

Knowledge:

• Knowledge of Commercial Insurance and Medical Policies.
• Knowledge of Medicare, Medicaid, and third party vendors.
• Knowledge of payer referrals, authorizations, and pre-determinations.
• Proficient in Microsoft Office.

Skills:

• Excellent customer service skills.
• Analytical and problem solving skills.

Abilities:

• Attention to detail.
• Able to type 50 words per minute.
• Office (Outlook, Word, Excel, PowerPoint).

Qualifications for the Role:

• 1-2 years of experience with medical insurance, benefits verification, prior authorizations, medical billing, or a related field preferred.
• Associate’s or Bachelor’s degree in healthcare, business, finance, other related field, or equivalent experience, a plus.
• EHR system experience.

Job Tags

Similar Jobs