Job Summary

The Senior Officer – Insurance Pre-Authorization will secure pre-approvals for all contracted payers and assist patient with insurance coverage.

Job Responsibilities 1

Studies insurance plans used most frequently with patients to understand the various nuances to communicate more effectively.

Documents basic insurance information in the patient’s file for quick reference.

Processes and submits insurance claims daily.

Monitors and follows up on outstanding claims.

Provides the appointment coordinator with patient names and amounts due, so effective collection over the counter can take place during the day.

Identifies patients in the daily schedule who are a financial concern, notes payment problems on the patient’s chart, and arranges a conference with them either before or at the time of the appointment.

Records all financial discussions with patients in their file.

Contacts patients who have not kept their financial agreement within a 5-day grace period to collect payment following the financial plan.

Prepares and mails patients’ statements each month on a regular billing cycle.

Sends information as requested by insurance companies such as x-rays, charting, narratives, and other documentation for processing the claim when applicable.

Provides insurance predetermination documentation to patients, contacts the patient to make financial arrangements, and schedules treatment.

Corresponds with insurance companies to resolve payment delays, requests for additional information, or to discuss denied treatment coverage.

Job Responsibilities 2

Handles all inquiries concerning insurance daily.

Contacts physician’s office to obtain current prescriptions and clinical documentation that is required by the plans.

Validates that the clinical documentation received is what is required by the plan.

Follows up on all pending PA’s within 48 hours.

Responds to urgent requests in a timely manner.

Submits all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.

Initiates re-authorizations that are set to expire 30 days prior to the term date.

Skills

Job Knowledge & Skills

Proficient in all Microsoft Office applications as well as medical office software.

Sound knowledge of health insurance providers.

Deep knowledge of Revenue Cycle Management within Billing, Collections, and Remittance posting.

Ability to work in a fast-paced environment.

Billing/Coding certification(s) preferred but not required.

Knowledge of payer websites, processes, local, state, and federal requirements

Job Experience

Minimum 2 years of experience in healthcare (required).

Proven experience in healthcare billing.

Minimum 1 years’ experience with data analytics (required).

Minimum 2 years of experience in GCC (preferred).

Competencies

Accountability

Collaboration

Leadership

Quality

Resilience

Education

Bachelor's Degree in Nursing or Science

Certificate in any related field