Medical Precertification & Authorization Expert

Northeast Georgia Health System; Gainesville (GA); Presencial; USD 38.000 - 52.000; Jornada completa

Descripción de la vacante

Northeast Georgia Health System is seeking an Administrative & Clerical professional to support pre-certification and insurance verification for inpatient and outpatient services. You will help determine patient responsibility, verify eligibility, and communicate with payers and physicians to obtain timely approvals.

Under the supervision of the Utilization Review Manager, you will deliver outstanding customer service, assist with financial counseling when appropriate, and help ensure accurate

Formación

• High School Diploma or GED required.
• Experience in insurance authorization or medical billing preferred.
• Strong communication and problem-solving skills.

Responsabilidades

• Ensure all inpatient and outpatient accounts are pre-authorized as required.
• Obtain and interpret clinical information to support pre-certification.
• Coordinate with physicians, case management, and payers to secure approvals.
• Verify patient eligibility and insurance details for hospital visits.
• Serve as liaison between clinical staff, patients, and payers regarding authorizations.
• Document pre-certifications accurately in patient accounts.
• Collaborate with appeals to overturn denied claims.
• Meet department goals for productivity, accuracy, and customer satisfaction.

Conocimientos

Independent work

Problem solving

Communication skills

Prioritization

PHI knowledge

Change management

Medical terminology

Insurance guidelines

Educación

High School Diploma or GED

Descripción del empleo

Northeast Georgia Health System is seeking an Administrative & Clerical professional to support pre-certification and insurance verification for inpatient and outpatient services. You will help determine patient responsibility, verify eligibility, and communicate with payers and physicians to obtain timely approvals.

Under the supervision of the Utilization Review Manager, you will deliver outstanding customer service, assist with financial counseling when appropriate, and help ensure accurate