What are the responsibilities and job description for the Pre-cert/Insurance Verification Clerk position at Kings Daughters Hospital And Health Services?
JOB SUMMARY
- The Pre-cert/Insurance Verification Clerk is responsible for coordinating insurance authorization and pre-certification of scheduled inpatient/outpatient tests and procedures and communicating denials as necessary. Clerk will assist in clerical/administrative duties in effort to maintain operations of department.
- Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members, providers, and additional resources as needed. Appeals for additional or change of services, authorization extension, and refers to additional resources when necessary.
- Records insurance information utilizing standardized documentation practices through the entire Pre-cert/Prior Authorization process for communications with pertinent staff.
- Independently maintains and works from the electronic medical record and additional databases.
- Obtains, interprets, and submits clinical documentation pertinent to the specific services requiring prior authorization to support reviews by the payer. Escalates to the Physician's office, effected service area, and any other applicable department when authorization is not obtained and/or benefits are inadequate.
- Obtains and documents prior authorization approval from insurance companies for services and Communicates professionally and timely to the physician/clinical staff regarding authorization status or delays.
- Follows up on denied authorization requests, escalates to Physician's office, effected service area, and any other applicable department and relays the necessary denial detail to the provider to facilitate the appeals and/or Peer to Peer reviews.
- Provides support to other departments to clarify claim submission and claim denial appeal efforts. May work to resolve claims denials related to the prior authorization process and may include account review, claim review, appeal preparation, and submission.
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Minimum requirement:
- High School Diploma or GED.
- Must type 35 words per minute.
- Associate's Degree
- One year pre-certification/insurance verification related experience
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Works indoors in an office/clinic setting
The noise level is usually moderate
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Constantly required to maintain a stationary position behind a computer.
Frequently required to move about inside the department.
Constantly required to communicate telephonically and face to face with colleagues and customers.
Constantly required to operate a computer and telephone.
Constantly required to lift and/or move up to 10 pounds.
Frequently required to lift and/or move up to 25 pounds.
Occasionally required to lift and/or move up to 50 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception
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