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

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 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!

Phelps Health serves over 200,000 residents in south-central Missouri. Phelps Health is county-owned, non-tax supported and is overseen by a five-member elected board. Phelps Health employs more than 1,900 people, including 100-plus providers. Phelps Health, which includes a hospital licensed for 240 patient beds, serves a six-county area, with its main campus and several clinics located in Rolla, Missouri. Phelps Health also has clinics in Salem, St. James, Vienna and Waynesville, Missouri.