This job is closed
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About the position
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.
Responsibilities
- Verify eligibility and obtain insurance benefits.
- Ensure pre-certification, authorization, and referral requirements are met.
- Determine which patient services have third party payer requirements.
- Obtain necessary authorizations for care via phone, fax, or payer websites.
- Provide detailed and timely communication to payers and clinical partners.
- Document appropriate information in the patient's record.
- Schedule all surgical procedures and assure appropriate clinical and insurance coding information is collected.
- Maintain accuracy in the upcoming surgical schedule.
- Communicate directly with Physician offices and foster working relationships with all departments involved.
Requirements
- High School Degree or Equivalent.
- 3 years of relevant work experience.
- Considerable knowledge and skill in the application of the techniques and practices of OR Scheduling.
- Considerable knowledge of complex medical terminology and advanced disease processes preferred.
- Typing speed of 35 wpm.
- Computer experience required.
