Insurance Verification & Preauthorization Specialist

LE01 Phelps County Regional Medical Center; United States; On-site; USD 38,000 - 48,000; Full time

Job summary

Phelps Health, a community hospital system in Rolla, Missouri, is seeking an Insurance Verification/Prior Authorization Team Member. You will verify patient benefits, determine eligibility, and obtain prior authorization before scheduled exams.

Ideal candidates have at least one year of clinical experience, familiarity with CPT and ICD-10 codes, and a high school diploma; Medical Assistant or LPN training is preferred.

Qualifications

• Must have strong knowledge of insurance benefits and eligibility.
• Experience with prior authorizations and clinical policy preferred.
• Familiarity with CPT & ICD-10 coding is beneficial.

Responsibilities

• Verifies patient insurance benefits and eligibility prior to scheduled exams.
• Obtains prior authorization/precertification from payers for procedures.
• Documents authorization decisions in clinical software per policy.
• Contacts payers to check status of authorizations and benefits.
• Verifies member plan eligibility before processing pre-certification requests.
• Applies clinical knowledge and policy as required.

Skills

Insurance verification

Prior authorization

CPT & ICD-10 codes

Medical terminology

Communication skills

Education

High school diploma

Registered Medical Assistant or Licensed Practical Nurse

Job description

Phelps Health, a community hospital system in Rolla, Missouri, is seeking an Insurance Verification/Prior Authorization Team Member. You will verify patient benefits, determine eligibility, and obtain prior authorization before scheduled exams.

Ideal candidates have at least one year of clinical experience, familiarity with CPT and ICD-10 codes, and a high school diploma; Medical Assistant or LPN training is preferred.