Job Detail

Position Summary: Coordinates all aspects of the outpatient/inpatient referral and precertification process including medical necessity review, benefits eligibility review, data entry and provider correspondence.

Essential Duties and Responsibilities:

• Coordinates and reviews emergency and nonemergency appointments and scheduled procedures and/or surgeries with patient, physician and/or facility prior to appointment or procedure.
• Obtains missing information including name, insurance provider, and contact telephone numbers.
• Processes referrals following section guidelines and established procedures including ICD 9 codes and procedure codes as required and obtains authorization/precertification from insurance carriers.
• Reviews and processes insurance and provider correspondence.
• identifies, tracks, and resolves on-going problems with the authorization process.
• Establishes and maintains pre-authorization files.
• Receives patient requests and determines authorization requirements.
• Answers referral questions and inquiries by phone and in person regarding referrals to a specialist or treatment facility.
• Contacts patients to inform them of referral or precertification appointment; answer patients' referral billing questions.
• Works with the manager to formulate a plan for professional development.
• Attends educational in-services as appropriate.
• Enters patient and referral information into computer systems following section/ department guidelines and established procedures.
• Verifies information for accuracy and completeness.
• Performs other related duties as required.

Qualifications

• Office experience in a medical setting
• Proficient in medical terminology and medical records management
• Knowledge of medical coding
• Experience with insurance verification and managed care processes
• Understanding of HIPAA regulations
• Relevant experience in a dental office is a plus

Job Type: Full-time

Pay: $21.00 - $24.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person