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Precertification / Patient Benefits Specialist
Location:
Wausau, WI
Description:
Position Summary The Patient Benefits Specialist is responsible to obtain pre-authorizations/pre-certifications as required by insurers for upcoming procedures, special testing, and referrals, and contacts patients prior to services to discuss insurance coverage and financial responsibility. Essential Job Functions and Responsibilities Obtains pre-authorizations/pre-certifications as required by health insurers or managed care providers for upcoming procedures, radiology or diagnostic testing, laboratory or other special testing. Works with reception and clinical staff to coordinate referrals to outside facilities or providers. Verifies Medicare, Medicaid and health insurance eligibility prior to upcoming services and procedures. Contacts patients prior to appointment or procedure to discuss insurance coverage and benefits and patient financial responsibility. Informs Patient Account Representatives of new or different insurance plans for patients, in case claims need to be resubmitted to the correct payer. Works with clinical staff to manage appointment frequency, insurance coverage and benefits for patients on infusion therapy. Maintains up-to-date knowledge of clinical guidelines, precertification requirements, and medical policies for services and procedures by routinely reviewing payer newsletters, regulatory and payer websites, and professional periodicals. Acts as administrator for the insurance websites and obtains and maintains logon access to all payers' websites. Performs other duties as assigned. Minimum Qualifications Education High school diploma or equivalent required. Licensure/Certification Advanced training/certification in medical billing, coding, and/or insurance preferred. Experience Minimum of one-year experience in a medical billing role is required, or equivalent education. Competencies Required Knowledge Working knowledge of medical and insurance terminology. Basic knowledge of medical and insurance terminology, CPT, HCPCS, and ICD-10 coding. Skills Possesses interpersonal, communication, and listening skills necessary to deal effectively and courteously with patients and all staff members. Proficient computer skills working in an Electronic Medical Record (EMR) and Practice Management software, and Microsoft Word, Excel, and the Internet. Demonstrates professionalism and respect in all forms of communication and correspondence. Abilities Ability to maintain strict confidentiality of fiscal and health information. Ability to work in a fast paced, multi-tasking environment and cope with rapidly changing demands while working as a team member. Ability to prepare and gather information accurately and efficiently. Job Posted by ApplicantPro
Company:
Gastrointestinal Associates, Sc
Posted:
December 26 2023 on ApplicantPro
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More About this Listing: Precertification / Patient Benefits Specialist
Precertification / Patient Benefits Specialist is a Clerical Benefits Specialist Job at Gastrointestinal Associates, Sc located in Wausau WI. Find other listings like Precertification / Patient Benefits Specialist by searching Oodle for Clerical Benefits Specialist Jobs.
Precertification / Patient Benefits Specialist is a Clerical Benefits Specialist Job at Gastrointestinal Associates, Sc located in Wausau WI. Find other listings like Precertification / Patient Benefits Specialist by searching Oodle for Clerical Benefits Specialist Jobs.