Pre-Cert Clerk

Desert Imaging Services; El Paso (TX); On-site; USD 32,000 - 45,000; Full time

Job summary

Desert Imaging Services in El Paso, TX seeks an Insurance Verification Specialist to confirm patient insurance coverage and pre-certifications prior to exams. You will document guarantor and patient details, and coordinate authorizations with third-party payers.

The role requires strong customer service, telephone etiquette, and accurate data entry. Prior medical office and billing experience are preferred, with a high school diploma or equivalent required.

Qualifications

• High School Diploma or equivalent.
• Minimum of one (1) year of customer service experience required.
• One (1) year experience working in a medical related office preferred.
• Experience and knowledge in handling telephones, computer terminals.

Responsibilities

• Verifies insurance coverage for patient exams and verifies pre-certification status with third party payers.
• Insures authorizations are processed prior to exams and maintains patient confidentiality.
• Documents guarantor information, patient information and protocols; assists in medical record reproduction as needed.
• Calculates patient fees, explains fees to patients, and sets up payment plans with supervisor approval.
• Works with physician offices to clarify orders, enter appropriate procedure codes, and ensure entries in the medical system.
• Identifies denials or issues with insurance and collaborates with billing to resolve them and prevent cancellations.

Skills

Customer service

Phone etiquette

Attention to detail

Data entry

Communication

Medical office experience

Education

High School Diploma or equivalent

Tools

EMR system

Billing software

Job description

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.These include but are not limited to the following:• Verifies insurance coverage for patient exams, makes written and/or verbal inquiries to third party payers to verify insurance status and pre-certification status• Stays abreast of patients added throughout the day and insures authorizations are processed prior to exam.• Performs various administrative tasks to expedite the verification process, including documentation of guarantor information, patient information and protocols, and medical record reproduction.• Participates in educational programs, in-service meetings, and workshops.• Maintain patient confidentiality is crucial.• Demonstrates exemplary telephone etiquette skills.• Works closely with all centers to make sure all patients are authorized before doing exam.• Calculates patient fees and explains fees to patients; sets up payment plans and gets approval from supervisor as needed; notifies patient of change in authorization.• Works with Physician offices to: o clarify physician’s orders; o clinical records for authorizations o obtains the appropriate procedure code and o enters into the medical system; obtains.• Recognizes variations and takes action to prevent undesirable appointment cancellations due to exams not being authorized; works with billing to resolve any insurance denials.• Performs other duties as assigned.• High School Diploma or equivalent;• Minimum of one (1) year of customer service experience required.• One (1) year experience working in a medical related office preferred.• Experience and knowledge in handling telephones, computer terminals.