Pre-Cert. And Eligibility Specialist

Description:

• Works with biller to address denials and appeals to insurance companies in an accurate and timely manner.
• Run and document patient benefits and Eligibility prior to visit/procedure, communicating patient payment responsibility, to front office, including any previous balances.
• Payments plans and financing options.
• Request and process pre-certs and authorizations as needed.
• Assist other office personnel in the performance of their duties as assigned.
• Maintain confidentiality of sensitive information and ensure compliance with HIPPA, OSHA, OIG, CMS, and all relevant regulatory agencies.
• Work with patients in a calm, caring manner.
• Responsible for follow up on insurance claims with no response over 45 days.
• Collect on insurance and patient outstanding balances.
• Establish payment plans, accept payment, and work aging reports.
• Obtain insurance verification, precertification, and authorization via phone and insurance payer portals for endoscopy center and clinic daily.
• Provide superior customer service in a fast-paced environment.

Additional skills and abilities:

• Knowledge of office procedures.
• Ability to speak clearly and concisely.
• Ability to read, understand, and follow oral and written instruction.
• Ability to develop goals, prioritize, organize, and make most efficient use of time.
• Ability to use individual judgement to solve problems and make decisions.

Requirements:

• 2-3 years of medical billing experience required.
• 1+ years of experience in pre-certification and Eligibility required.
• Ability to multitask.