Pre Certification and Insurance Specialist 

POSITION SUMMARY: The Pre-Certification and Insurance Specialist ensure that all patient insurance is verified as active, any pre-certifications and or referrals are obtained, and both office staff and patients are made aware of responsible balances due.

ESSENTIAL RESPONSIBILITIES:

• Develops effective relationships with insurance company representatives.
• Utilize ICD-9 and CPT codes to ensure proper authorization for procedure and claims payment.
• Responsible for explaining benefits, the billing process and financial responsibilities to patients.
• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of know or potential issues.
• Responsible for obtaining and communication pre-authorization as needed per insurance company requirements.
• Responsible for obtaining and communicating all Primary Care Physicians referrals as required per insurance.
• Responsible for tracking, obtaining and extending authorizations from various carriers ina timely manner.
• Record insurance information to maintain data through the Referral/Insurance Verification process and communicates insurance information to pertinent staff.
• Independently works from the Eyecare database, Availity, CSnap and other electronic resources.
• Track a significant amount of data and information, preparing and producing meaningful information.
• Provides detailed, accurate and current clinical information to insurance representatives.
• Follow up on requests for authorization for service on unpaid claims as requested by Central Billing.
• Maintain a strong working knowledge of precertification and referral requirements by insurance carrier.
• Perform any other related duties as directed by the immediate supervisor

EDUCATION AND/OR EXPERIENCE:

• High School diploma or equivalent
• Minimum of one (1) year experience in the role of Pre-Certification and Insurance Specialist, Intake Representative, Insurance Representative, or Prior Authorization Representative or related field in a healthcare setting.

To search for an open position, please go to http://MidwestEyeConsultants.appone.com