Pre-CertEligibility Specialist

San Antonio, TX - USA

Monthly Salary: Not Disclosed

Posted on: 23 hours ago

Vacancies: 1 Vacancy

Job Summary

JOB SUMMARY
The Precertification/Eligibility Specialist is primarily responsible for obtaining pre-authorizations for high-cost services and therapeutics ordered by Urology San Antonio Providers. This position also serves as a safety net for ensuring insurance benefits for patients are verified prior to receiving services at Urology San Antonio.

DUTIES AND ESSENTIAL JOB FUNCTIONS
Completes and submits any forms and clinical documentation required to secure appropriate preauthorization(s) and insurance benefit(s) for scheduled services.
Enters comments in the EMR (eCommunications) that are clear and concise so that the clinic(s) know the coverage dates and any policy limits deductibles and co-pays etc. that may need to be communicated with patients.
Ensures authorization number is properly documented in EMR necessary for accurate and timely claims submission to the respective insurance payers.
Prepares Letter(s) of Medical Necessity and paperwork required for submitting appeals by insurance(s) to overturn denials for lack of authorization and /or lack of medical necessity as needed.
Sets up Peer-to-Peer reviews between physician and insurance carrier when prior authorization is denied if necessary.
Ensures proper insurance payer plan is documented in patient management system.
Performs eligibility verification by managing Batch Eligibility process assignments accessing respective payer websites and/or calling insurances directly.
Works claim rejections for eligibility timely to ensure claims are processed to the correct insurance payer.
Interacts with patients when eligibility and benefits cannot be verified through the various payer portals etc.
Obtains prepayment(s)/payment arrangement(s) for patients receiving cancer therapy and other services as appropriate.
Performs other duties as assigned.
Other functions and Responsibilities
This job description covers or contains a comprehensive listing of most activities duties or responsibilities required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.

COMPETENCIES
Patient & Customer Focus
Ethical ConductFlexibility
Initiative
Personal Effectiveness/Credibility
Stress Management/Composure
Ability to use MS Office programs within the scope of responsibilities and tasks.
Multitask and coordinate multiple projects and assignments simultaneously and completing assigned tasks accurately and on a timely basis
Ability to adapt in a continually changing environment and the ability to work under tight deadlines
Strong attention to detail and organizational skills
Excellent written and verbal communication skills
Ability to work well independently
Maintain confidentiality

QUALIFICATIONS
Required
High School Diploma or GED
2 years of experience with obtaining preauthorizations and/or benefits verifications in a medical office or hospital setting
Proficient knowledge of CPT/HCPCS and ICD-10 codes
Knowledge of insurance(s) preauthorization requirements

Required Experience:

JOB SUMMARYThe Precertification/Eligibility Specialist is primarily responsible for obtaining pre-authorizations for high-cost services and therapeutics ordered by Urology San Antonio Providers. This position also serves as a safety net for ensuring insurance benefits for patients are verified prior...