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Pre-Certification Specialist (32283) in Lafayette, Louisiana at GI Alliance

NewIndustry: Healthcare / Health ServicesJob Function: Manufacturing
GI Alliance
Lafayette, Louisiana, 70501, United States
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Job Description

Pre-Certification Specialist (32283)
Job DetailsJob Location: Southern Urology Main Lafayette - Lafayette, LA 70508
Position Type: Full Time
Job Shift: Day
Description

Description


PRE-cert Specialist

QUALIFICATIONS:
  • High School Diploma or Equivalent.
  • Certified as a CMA/MOA/Billing and Coding is preferred.
  • A minimum of two (2) years’ experience in the medical field or physician office practice is preferred.
  • Needs to pass a basic background check for criminal history, drug screening & OIG exclusions.

    • ROLE AND RESPONSBILITIES:
  • Obtain and maintain prior authorizations from insurance companies regarding procedures both in-office and outlying facilities as well as medications or testing ordered by the providers.
  • Collaborates with providers, clinical staff, and others to timely resolve any authorization gaps identified.
  • Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date.
  • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
  • VA authorization numbers and follow ups
  • Checks the patient's insurance benefits and determines the amount owed prior to the procedure.
  • Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided as needed.
  • Any other duties deemed necessary by the Clinical Director

    • OTHER BASIC SKILLS
  • Solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits, in addition to medical terminology.
  • Ability to communicate and interact effectively and professionally with patients, coworkers, and other practice customers.
  • Ability to work autonomously with minimal supervision on assigned tasks as well as accept direction and real time coaching on given task.
  • Ability to prioritize in a fast-paced environment.
  • Maintains the medical record, ensuring confidentiality and accuracy in accordance with organization standards and HIPAA laws.

    • Job Location

    Lafayette, Louisiana, 70501, United States

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