Qualification – Graduate
Job Description :
- Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt, pt estimation calculation
- Successfully works with payers via electronic/telephonic and/or fax communications.
- Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
- Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits.
- Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
- Communicates with clinical partners, financial counselors(Pt estimation), and others as necessary to facilitate authorization process.
- Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality