ProMedica
Performs verification of insurance coverages and prior authorization/certification of scheduled services with payers. Provides clinical review and document submission of pre-certification requests for scheduled elective services.
ACCOUNTABILITIES
Reviews patient’s insurance coverage for eligibility and network guidelines.
Reviews insurance companies’ authorization guidelines.
Checks for the clinical documentation for elective scheduled services such as advance diagnostic imaging and surgical procedures.
Initiates the authorization with the payer for those services that doesn’t require a clinical nurse.
Follows up with the payers for the authorization decision of approved or denied.
Provides communication to the physician offices and patients when a case needs re-scheduled or cancelled.
Completes consistent review of individual payer policies to identify changes affecting authorizations. Maintains current knowledge on medical criteria relating to prior authorization requirements by third party payers and medical necessity requirements.
Participate in process development and improvement as it relates to authorizations, communication, education, etc.
Thoroughly documents actions taken in appropriate information system(s).
Self-pay and referenced based communication to both physician offices and patients.
Pricing estimates.
Additional responsibilities/duties will be assigned based on teamwork load and competency
This position can be worked remote.
Job Requirements
REQUIRED QUALIFICATIONS
Must have a high school diploma or equivalent.
PREFERRED QUALIFICATIONS
Must demonstrate the ability to accurately and independently solve problems by taking a basic skills test and scoring a minimum of 80%
1 year experience in medical registration, billing, customer service or collection preferred but not necessary
Have intermediate computer knowledge, skills and proficiency including general office applications.
Have strong organizations skills and the ability to multi-task.
Demonstrate the ability to accurately and independently solve problems.
Have the ability to manage large volumes of work, ability to quickly learn and retain information regarding issues that present themselves.
WORKING CONDITIONS
Personal Protective Equipment: None work from home position
Physical Demands: Frequent sitting and computer use.
Salary Range: $31,200 – $58,968
The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact
ProMedica
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