Pre Authorization Representative-Full Time

Orthopedic Associates Of•Englewood Cliffs, NJ

11d•$20 - $25

About The Position

The Pre-Certification and Authorization Rep is responsible for performing all insurance precertification and authorization requirements for patients scheduled for services in an Orthopedic practice. This includes validating demographic information and insurance eligibility coverage to ensure financial clearance and that services are cleared to be performed prior to the date of service.

Requirements

High school graduate/GED required
1–2-year experience required
Ability to communicate in English, both Orally and in writing required
Accurate computer data entry skills required
Knowledge of CPT and ICD-10 coding
Strong communication abilities
Attention to detail
Organizational skills

Nice To Haves

Knowledge of medical office and terminology preferred
Experience with standard office equipment (Phone, fax, copy machine, scanner, email/voice mail) preferred
Experience with standard office technology in a Window based environment preferred.
Familiarity with EHR systems

Responsibilities

Verify patient’s insurance benefits for all in-office procedures, treatments, including HA injections, MRI, EMG’s, and Surgical procedures
Notifies insurance companies of services being rendered, and obtains any necessary authorizations, ensuring notification and verification is complete for each order.
Obtains and verifies any necessary additional demographic and/or billing information.
Actively obtains authorization for referrals same day as ordered by physicians.
Coordinate with provider’s offices and medical staff to ensure all necessary documentation is obtained for purposes of pursuing a successful authorization approval.
Accurately records all actions, interactions, and authorizations surrounding the insurance process for each patient into the Electronic Medical Record (EMR) system
Researching and appealing denied authorization, including setting up Peer to peer calls and Appeals
Provides quality customer service to all patients promptly and have professional communication.
Additional experience in WC/No Fault claims.
Other duties as assigned.
Work as a team member within the patient services department and all other departments.
Must be able to recognize and respond appropriately to urgent/emergent situations.
Establish and maintain effective working relationships.
Effectively cope with typical job stress.
Document work processes as required
Review and process pre-authorization requests for medical services and procedures.
Communicate with healthcare providers to obtain necessary documentation and information.
Interact with insurance companies to verify coverage and obtain approvals.
Maintain accurate records of all pre-authorization requests and their outcomes.
Provide timely updates to patients and healthcare providers regarding the status of pre-authorization requests.