Insurance Pre-Auth & Eligibility Coordinator

Greater Maryland Pain Management; Odenton (MD); Vor Ort; USD 42.000 - 60.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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

Kenntnisse

Insurance knowledge

Medical terminology

Coding proficiency

Documentation

Communication

Jobbeschreibung

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.