Patient Access Preauthorization/Precertification Specialist I
$38,896–$38,896 year
HybridBaltimore, Maryland, United States
Job Summary
Verify eligibility and conformance to departmental managed care requirements and contracts while obtaining insurance referrals and pre-authorizations for scheduled procedures, hospital admissions, medications, and medical equipment. Review provider schedules to confirm correct insurance information, cross-reference stored documentation for completeness, and initiate authorization activities. Maintain ongoing communication with insurance companies to determine benefit eligibility and deductible status, responding efficiently to inquiries regarding authorizations and scheduling. Enter relevant data into IDX and SMS/Invision authorization fields to ensure accurate billing information is submitted, obtaining missing pre-certification numbers and rescheduling appointments as necessary. Monitor the MedConnect Pre-Authorization Work Queue, communicate with designated provider staff regarding required documentation, and maintain current knowledge of regulatory changes.
Required Qualifications
- High School Diploma or GED
- 1-2 years' experience in patient accounting, patient access or pre-arrival services functions
- An equivalent combination of experience and college education in accounting, finance or healthcare administration
- Working knowledge and demonstrated proficiency in payer authorization and clearance processes
- Basic working knowledge of UB04, HCFA 1500 or equivalent and payer responses
- Some knowledge of medical terminology and CPT/ICD-10 coding
- Excellent communication, analytical, interpersonal and organizational skills
- Proficient uses of hospital registration and/or billing systems and personal computers as well as Microsoft Excel and Word applications
- Ability to type 35 WPM
- Must be available for intermittent on-site obligations based on operational requirements
- Must be available for on-site work, if needed, at locations throughout the DC, Maryland, and Virginia area
Desired Qualifications
- Experience with the MedStar Managed Care Matrix
- Experience with the MedStar online Handbook
- Experience with the IDX application
- Experience with the Appointment Data Form (ADF)
- Experience with SMS/Invision authorization fields
- Experience with the MedConnect Pre-Authorization Work Queue
- Experience with Peer-to-Peer requests
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