Insurance Authorization and Eligibility Coordinator

Greater Maryland Pain Management; Odenton (MD); On-site; USD 42,000 - 60,000; Full time

Job summary

Greater Maryland Pain Management is seeking a qualified Pre-Authorization Specialist to obtain and complete insurance pre-certifications for clinical procedures. You will verify benefits, coordinate with insurers, patients and staff, and ensure proper documentation in charts.

The role requires knowledge of insurance requirements, medical terminology and coding (ICD/CPT), strong communication, and the ability to work with minimal supervision to keep procedures on schedule.

Qualifications

• Proficient knowledge of insurance requirements and medical terminology.
• Experience with ICD/CPT coding for pre-authorization.
• Strong communication and coordination with insurers, patients and staff.

Responsibilities

• Obtains and completes insurance pre-certifications and authorizations for clinical procedures.
• Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.
• Maintains complete and accurate documentation in patient charts.
• Develops and maintains effective relations with insurance companies, physicians and medical office staff.
• Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.
• Ability to work with minimal supervision.
• Monitors new patient report and maintains organized list with status of pre-certification process.
• Verifies insurance eligibility and benefits via phone and/or internet access. Updates insurance policy information.
• Checks insurance payment policy for scheduled procedures and obtains prior authorization when required.
• Verifies receipt of all necessary pre-authorization documents prior to procedure.
• Communicates effectively with the facility in which the procedure will be performed as needed.
• Assigns appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
• Notifies primary care physician for managed care plans that require PCP authorization.
• Serves as a resource on insurance, billing and customer service for reception.
• Performs other duties or functions as assigned

Skills

Insurance knowledge

Medical terminology

Coding proficiency

Documentation

Communication

Job description

• This position is responsible for obtaining and completing all insurance pre-certifications and authorizations as required for various clinical procedures.
• Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.
• Maintains complete and accurate documentation in patient charts.
• Develops and maintains effective relations with insurance companies, physicians and medical office staff.
• Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.
• This position requires the ability to work with minimal supervision.
• Monitor new patient report and maintain organized list with status of pre-certification process.
• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information.
• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
• Verify receipt of all necessary pre-authorization documents prior to procedure
• Communicate effectively with the facility in which the procedure will be performed as needed.
• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
• Notify primary care physician for managed care plans that require PCP authorization.
• Serve as a resource on insurance, billing and customer service for reception.
• Perform other duties or functions as assigned