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Coordinator

SCP ENT & Allergy Services, LLC
Marietta, GA Full Time
POSTED ON 5/19/2024

Key Responsibilities : 1. Authorization Management : - Obtain and verify pre-certifications or referrals for medical procedures, surgeries, and tests as required by insurance providers.

  • Collaborate with physicians, nurses, and other clinical staff to gather necessary clinical information for precertification requests.
  • Communicate with insurance providers to ensure timely submission and approval of requests. - Notify clinical staff and patients of any issues or denials.

3. Documentation : - Maintain detailed records of all communications and authorization documents. - Update patient files with relevant pre-authorization information.

  • Ensure accurate entry of authorization details into electronic health records or other tracking systems. 4. Billing Support : - Assist the billing department in resolving claim denials related to lack of authorization.
  • Provide necessary documentation or clinical information to support appeals when necessary. 5. Regulatory Compliance : - Stay updated with changes in insurance policies and governmental regulations pertaining to pre-authorization.
  • Ensure processes and procedures are compliant with regulations and industry best practices. 6. Continuous Improvement : - Monitor and analyze precertification process efficiency and recommend changes for improvement.
  • Participate in training and professional development activities. Qualifications : - High school diploma required; Associates or Bachelors degree in a related field preferred.
  • Experience in medical billing, insurance, or a related field. - Familiarity with medical terminology. - Strong organizational skills and attention to detail.
  • Excellent communication skills, both verbal and written. - Proficiency with electronic health record systems and office software.

    • Last updated : 2024-05-19

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