Precert Specialist - Business Office

Imperial Health; Lake Charles (LA); On-site; USD 42,000 - 62,000; Full time

Job summary

Imperial Health in Lake Charles, LA seeks an Insurance Pre-Certification Specialist to gather benefits and eligibility information from insurers and verify patient eligibility. The role involves communicating with clinicians, obtaining required documentation, and relaying cost estimates for treatments.

The candidate should have basic insurance knowledge, experience with EMR/Practice Management systems, and strong computer skills. The position is full-time and on-site.

Qualifications

• Basic knowledge of managed care.
• Basic computer skills including typing and 10-key.
• Prior knowledge of insurance is helpful.
• Medical terminology knowledge is helpful.

Responsibilities

• Verify insurance verification, prior approvals, and authorization requirements before procedures.
• Communicate with physicians and staff to obtain documentation requirements.
• Provide clinical documentation to payers via phone, fax, or website.
• Contact referring providers as needed.
• Document authorization approvals and denials in Practice Management systems with codes and dates.

Skills

Managed care knowledge

Computer basics (typing/10-key)

Insurance knowledge

Medical terminology

Communication with clinicians

Education

High school diploma

Tools

EMR systems

Practice Management

Microsoft Outlook

Microsoft Word

Microsoft Excel

Internet proficiency

Job description

Job Title:

Insurance Pre-Certification Specialist

This position is:

Full Time

Position Location:

Lake Charles, LA

GENERAL SUMMARY OF DUTIES:

The purpose of this position is to gather benefits and eligibility information from insurance companies, to obtain eligibility verification for patients, and to relay benefit information and an estimated cost of treatment.

ESSENTIAL FUNCTIONS:

1. Responsible for assuring appropriate insurance verification, prior approvals, and all authorization requirements are obtained prior to the patient's arrival for surgery or procedure.


2. Communicate with physicians, mid-level providers, and clinical staff as needed to obtain and understand clinical documentation requirements


3. Provide required clinical documentation to payers via phone, faxed forms, and/or website


4. Contact Referring and other external providers as needed


5. Clearly document authorization approvals and denials in Practice Management systems including authorization numbers and associated codes, dates, and other relevant data.

KNOWLEDGE:

1. Basic knowledge of managed care.


2. Basic computer knowledge, typing and 10-key skills needed


3. Previous knowledge of insurance is helpful.


4. Previous medical terminology helpful.

EDUCATION:

High school diploma or equivalent

EXPERIENCE:

1. Experience with obtaining prior authorizations is highly preferred.


2. Moderate level of computer skills including EMR (electronic Medical record), Practice Management system, basic office applications including Outlook, Word, Excel and use of the internet.


3. Customer service experience; preferably in healthcare related environment.