Precertification and Authorization Rep-Remote
About the position This position is a 100% remote work. Individual may live anywhere in the US. The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. Responsibilities • Resolve referral, precertification, and/or prior authorization to support insurance specific plan requirements. • Process pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts. • Work on assigned registration denials for government and non-government accounts. • Conduct pre-appointment insurance review (PAIR) and denials recovery functions. • Adhere to quality assurance guidelines and established productivity standards. Requirements • High School Diploma or GED and 2+ years of relevant experience required OR Bachelor's Degree required. • Ability to read and communicate effectively. • Basic computer/keyboarding skills. • Intermediate mathematic competency. • Good written and verbal communication skills. • Knowledge of proper phone etiquette and phone handling skills. • General knowledge of healthcare terminology and CPT-ICD10 codes. • Basic knowledge of and experience in insurance verification and claim adjudication. Nice-to-haves • Knowledge of denial codes. • Knowledge of and experience using an Epic RC/EMR system. • Healthcare Financial Management Association (HFMA) Certification Preferred. Apply tot his job