Billing and Insurance Specialist Job In Rolla, Missouri
Precertification and Insurance VerificationNext Steps... Apply Now
Rolla, Missouri 65401 Type of Facility: Hospital
- The Insurance Verification/Prior Authorization Team Member is responsible for verifying patient eligibility, determining benefits, and to obtain insurance prior authorization prior to patient’s exam date and time.
- Obtains or assists in receiving prior authorization/precertification from payers for surgical, laboratory, chemotherapy, radiation therapy and diagnostic imaging procedures scheduled to be performed.
- Processes multiple patient prior authorization/precertification requests at any given time in an efficient and accurate manner. Documents prior authorization/precertification decisions following clinical policy in clinical software.
- Confirms member plan eligibility and benefits prior to processing a request for pre-certification. Utilizes clinical knowledge, clinical resources or clinical policy as required.
- Makes and receives calls on the status of authorizations. The precertification team member speaks to the clinical nurse reviewer from the various insurance carriers on a daily basis to obtain pre-certifications.
- The precertification team member demonstrates knowledge of rules for all insurance payor guidelines.
- Pre-certification team demonstrates exceptional customer service and interacts effectively with physicians, patients, staff and the healthcare community.
High School diploma or Equivalent required. Additional training/Schooling such as a technical or junior college directly related to Medical Assistant/Medical Billing highly preferred.
- Minimum 1 year of clinical experience in a health care organization required. Experience in insurance verification and prior authorization process preferred. Knowledge of Medical terminology and CPT & ICD-9/10 codes preferred.
- Valid MO or Compact State LPN license or an accredited Registered Medical Assistant required if programs were completed.
- Ability to receive and express detailed information through oral communications, visual acuity, and the ability to read and understand written directions. Normal mental concentration with repetitive operations for a long period of time. Communicates well both verbally and in writing, creates accurate and punctual reports, shares information and ideas with others, has good listening skills. Ability to stand, walk, sit, and reach. Occasionally lifts and transports items weighing up to ten (10) pounds.
- Standard office conditions with more than average noise. Periodic contact with conditions such as fumes, noise, chemicals, hazards, and/or diseases.
Phelps Health, one of the largest employers in the region, is seeking talented people who are committed to integrity, compassion, innovation and philanthropy. Phelps Health has a variety of job opportunities available, including clinical positions, such as nurses and care providers, as well as non-clinical careers, such as support staff. All of our employees make a difference in the patient experience, no matter what role they serve. Find your career at Phelps Health today.