Insurance Verification & Pre-Auth Clerk

Ozarks Healthcare; West Plains (MO); On-site; USD 40,000 - 56,000; Full time

Job summary

Ozarks Healthcare is seeking a detail-oriented compliance and insurance verification specialist to support accurate patient billing and admissions processing. You will review documentation, verify payer requirements, and ensure pre-certification and authorization are in place for admitted patients.

The role focuses on adhering to Medicare, Medicaid, managed care, and commercial payer guidelines, ensuring accurate reimbursement and smooth medical records review.

Qualifications

• Knowledge of Medicare/Medicaid guidelines and payer requirements.
• Attention to detail in insurance verification and reimbursement processes.
• Ability to review and interpret medical documentation for compliance.

Responsibilities

• Complies with Medicare, Medicaid, Managed Care and commercial payer policies for pre-authorization and pre-certification requirements.
• Obtains authorizations and pre-certifications for admitted patients as per insurance plan.
• Verifies insurance eligibility and benefits; reviews and ensures accuracy of patient coverage information.
• Determines primary payer when coordination of benefits is required.
• Serves as a resource on inpatient reimbursement and payer guidelines for the team.
• Works on various projects as requested by supervisor.

Job description

Ozarks Healthcare is seeking a detail-oriented compliance and insurance verification specialist to support accurate patient billing and admissions processing. You will review documentation, verify payer requirements, and ensure pre-certification and authorization are in place for admitted patients.

The role focuses on adhering to Medicare, Medicaid, managed care, and commercial payer guidelines, ensuring accurate reimbursement and smooth medical records review.