Precert & Insurance Verification Team Member | Full-Time, Day Shift

Phelps Health; Rolla (MO); On-site; USD 38,000 - 52,000; Full time

Job summary

Phelps Health in Rolla, MO is seeking an Insurance Verification/Prior Authorization Team Member to verify patient eligibility, determine benefits, and obtain pre-authorization before exams.

You will handle authorizations for surgical, lab, and imaging, contact payers, and verify plan benefits. The role requires at least 1 year in healthcare and familiarity with CPT and ICD-10 codes.

A high school diploma is required; RMA or LPN preferred.

Qualifications

• High school diploma or equivalent is required.
• Graduate of a Registered Medical Assistant or Licensed Practice Nurse program preferred.
• Minimum 1 year of clinical experience in a health care organization.
• Experience in insurance verification and prior authorization preferred; knowledge of CPT & ICD-10 codes preferred.

Responsibilities

• Obtains or assists in obtaining prior authorization/precertification from insurance payers for procedures.
• Processes multiple prior authorization requests efficiently and documents decisions.
• Makes and receives calls on status of authorizations and verifies benefits.
• Confirms member eligibility and benefits prior to pre-certification; uses clinical resources as needed.

Skills

Medical terminology

CPT & ICD-10 codes

Insurance verification

Prior authorization

Education

High school diploma or equivalent

Registered Medical Assistant (RMA)

Licensed Practice Nurse (LPN)

Job description

Phelps Health is a 2000-employee-strong hospital and healthcare system serving the heart of small-town Missouri.

No matter where you start with us, we’re committed to taking our team to the top. If you’re ready for the challenge of providing life-saving care or supporting those who do, read on to find your fit in the Phelps Health family.

General Summary

The Insurance Verification/Prior Authorization Team Member is responsible for verifying patient eligibility, determining benefits, and to obtain insurance prior authorization prior to patient’s exam date and time.

Essential Duties And Responsibilities

• Obtains or assists in obtaining prior authorization/precertification from insurance payers for surgical, laboratory, and diagnostic imaging procedures scheduled to be performed.
• Processes multiple patient prior authorization/precertification requests at any given time in an efficient and accurate manner. Documents prior authorization/precertification decisions following clinical policy in clinical software.
• Makes and receives calls on the status of authorizations and verifies benefits over the phone and/or via insurance payer websites.
• Confirms member Plan eligibility and benefits prior to processing a request for pre-certification. Utilizes clinical knowledge, clinical resources or clinical policy as required.

Education

• High school diploma or equivalent required.
• Graduate of a Registered Medical Assistant or Licensed Practice Nurse program preferred.

Work Experience

• Minimum 1 year of clinical experience in a health care organization required. Experience in insurance verification and prior authorization process preferred. Knowledge of Medical terminology and CPT & ICD-10 codes preferred.

Certification/License

• N/A

Mental/Physical Requirements

• Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Communicates well both verbally and in writing, creates accurate and punctual reports, shares information and ideas with others, has good listening skills. Ability to stand, walk, sit, and reach.

Working Conditions

• Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.

At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around, and we invite you to see for yourself!