Precertification Representative - Marshall Internal Medicine

Marshall Health • Huntington, WV

5d

About The Position

This role is responsible for managing the precertification process for scheduled procedures. This involves utilizing various systems to capture necessary documentation for coding, communicating with insurance carriers, and informing patients of any balances due. The representative will also document authorization details and provide backup support to clinics as needed.

Requirements

• Completion of a certification program such as Medical Assistant, Nurse Assistant, or equivalent required.
• One year of billing or clinical experience in a health care organization is required.

Responsibilities

• Utilizes electronic and manual systems to identify and capture source documentation for coding of ordered procedures, tests, surgeries, etc.
• Answers phone calls and/or inquiries from insurance carriers or other parties to assist in the prior authorization for scheduled procedures.
• Performs the precertification process for scheduled procedures, including communication of any balances due to the patient.
• Communicates and appropriately documents the details of the procedure authorization, including approved CPT code, diagnosis code, and Date of Service range.
• Documents authorization details in the patient medical record per approved protocols.
• Provides backup to clinics as needed.
• Performs other duties as assigned or requested.

What This Job Offers

• Career Level: Entry Level
• Education Level: Associate degree