Precertification & Insurance Authorization Specialist

20 Northeast Georgia Medical Center, Inc.; United States; Vor Ort; USD 40.000 - 54.000; Vollzeit

Zusammenfassung

Northeast Georgia Health System is seeking an Administrative & Clerical professional to manage pre-certification processes for inpatient and outpatient services under the Utilization Review Manager. The role emphasizes outstanding customer service, accurate insurance verification, and effective financial counseling with payers and patients.

The ideal candidate offers 3–5 years in related healthcare operations, holds a High School Diploma or GED, and may have AAPC/AHIMA/CPC certification.

Qualifikationen

• High School Diploma or GED.
• 3–5 years of experience in insurance authorization, precertification, medical billing, revenue cycle, patient access, or related healthcare operations.
• AAPC, AHIMA or CPC certification strongly preferred.

Aufgaben

• Pre-authorize inpatient and outpatient accounts per guidelines.
• Interpret clinical information for pre-certification and medical justification.
• Collaborate with physicians' offices, Case Management, Utilization Review, and patients to obtain supporting data for payer pre-authorization.
• Obtain complete and accurate insurance information and verify patient eligibility.
• Act as liaison between clinical staff, departments, patients, physicians and payers regarding denials/delays.
• Document pre-certification activities thoroughly and support process-improvement initiatives.
• Assist the appeals department with information to overturn denied claims.

Kenntnisse

Customer service

Communication

Team collaboration

Ausbildung

High School Diploma or GED

Jobbeschreibung

Northeast Georgia Health System is seeking an Administrative & Clerical professional to manage pre-certification processes for inpatient and outpatient services under the Utilization Review Manager. The role emphasizes outstanding customer service, accurate insurance verification, and effective financial counseling with payers and patients.

The ideal candidate offers 3–5 years in related healthcare operations, holds a High School Diploma or GED, and may have AAPC/AHIMA/CPC certification.