Insurance Pre-Cert/Authorization Coordinator - Hospital Based

Peachford Hospital • Atlanta, GA

399d

About The Position

The Insurance Pre-Certification Coordinator at Peachford Hospital is responsible for obtaining prior authorizations for patient admissions and ensuring compliance with insurance requirements. This role is crucial in facilitating the delivery of inpatient, outpatient, and ancillary care by managing insurance benefits and documentation effectively. The coordinator works closely with insurance carriers and internal departments to ensure timely authorizations and educate staff on insurance-related processes.

Requirements

• Bachelor's degree in a business or social sciences field required, or equivalent healthcare/insurance experience.
• Previous experience working in billing, prior authorization, or insurance verification required.
• Full knowledge of third-party payers and pre-authorization requirements.
• Knowledge of online insurance eligibility systems.
• Ability to communicate effectively with staff and providers in a tactful manner.

Responsibilities

• Gather patient insurance benefit information needed for pre-certification from insurance companies and document it in the electronic medical record.
• Ensure timely and accurate insurance authorizations are in place prior to services being rendered when possible.
• Apply knowledge of Medicare, Medicaid, and third-party payer requirements to ensure information obtained is complete and accurate.
• Contact insurance carriers to obtain authorization/notification and pre-certifications.
• Collaborate with internal departments to provide account status updates and coordinate the resolution of issues.
• Educate staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, and documentation requirements.
• Maintain knowledge of Medicare, Medicaid, and third-party payer requirements, guidelines, and policies.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Bachelor's degree