About the position
This position is a 100% remote work. Individual may live anywhere in the US. The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations.
Responsibilities
• Resolve referral, precertification, and/or prior authorization to support insurance specific plan requirements.
• Process pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts.
• Work on assigned registration denials for government and non-government accounts.
• Conduct pre-appointment insurance review (PAIR) and denials recovery functions.
• Adhere to quality assurance guidelines and established productivity standards.
Requirements
• High School Diploma or GED and 2+ years of relevant experience required OR Bachelor's Degree required.
• Ability to read and communicate effectively.
• Basic computer/keyboarding skills.
• Intermediate mathematic competency.
• Good written and verbal communication skills.
• Knowledge of proper phone etiquette and phone handling skills.
• General knowledge of healthcare terminology and CPT-ICD10 codes.
• Basic knowledge of and experience in insurance verification and claim adjudication.
Nice-to-haves
• Knowledge of denial codes.
• Knowledge of and experience using an Epic RC/EMR system.
• Healthcare Financial Management Association (HFMA) Certification Preferred.
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