-High School Diploma or general education degree (GED) required.
-2–3 years’ experience in medical or related field; knowledge of medical terminology and procedures.
-Knowledge of health insurance industry practices and/or medical billing procedures.
-Computer literacy required, experience with medical scheduling/billing systems is desired.
Obtains all pertinent insurance benefit information and/or pre-certification approval for patients scheduled to receive services at an Imaging site, center or facility. Contacts doctors’ offices for accurate, timely and complete information to ensure reimbursement of contracted procedures. Records all benefit and certification information into the applicable computer system and communicates with scheduling in accordance to documented work processes. Coordinates coverage restrictions to prevent payment problems. Resolves higher level issues. May assist in training new hire staff. Ensures every customer receives the highest level of customer service.
Specific duties include, but are not limited to:
1. Responsible for ensuring insurance companies are contacted to complete the verification process through phone calls and/or web based sites and/or is responsible for obtaining authorizations/ pre-certifications from insurance companies and radiology management companies. Prioritizes workload to ensure deadlines are met.
2. Documents the insurance and authorization verification information in the applicable computer system in accordance with documented work processes. Ensures any coverage restrictions are documented and addressed to avoid payment problems.
3. Ensures authorizations /pre-certifications issued are correct. May contact doctor’s offices to request any necessary corrections to authorizations/pre-certifications and/or additional clinical information to needed to obtain an authorization/pre-certification.
4. Interfaces with customers and Alliance’s managed care department regarding any contracting issues.
5. Acts as source of reference for team members.
6. May assist supervisors and trainers in mentoring new team members.
7. Completes any additional job duties as assigned.
- 3 years ago - save job