Insurance Verifier

Location: Steward Medical Group - North

Posted Date: 2/5/2021

Principal Duties and Responsibilities:

1. Verifies insurance benefits and obtains prior authorization for patient exams being performed at Hawthorn Medical/SMG. .

1. Records all insurance benefit and certification information in the applicable computer system. Completes and distributes all paperwork required by insurance and Imaging department.

1. Gathers all necessary information from secretaries to obtain pre-authorizations and pre-certifications as stipulated by each individual health plan for Diagnostic Imaging services and communicates with scheduling when additional information is required.

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1. Interfaces on a daily basis with insurance carriers, individual insurance provider authorizers, medical groups, and scheduling coordinators to maximize efficiency.

1. Follows company/department policies and procedures as well as compliance standards. Notifies management staff when problems arise.

1. When providing scheduling services, maintains communication with the ordering physicians and their secretaries to schedule patients for a variety of imaging procedures.

1. Knowledge regarding the appropriate exam preparation, appointment arrival time and contraindications. Able to communicate these instructions to both the scheduling secretaries and the patients that may call directly.

1. Utilizes payer websites to determine eligibility and benefit determination to ensure radiology exams are covered and to prevent denials.

Qualifications:

• High school diploma or equivalent required, associates degree or Secretarial certificate preferred.
• Minimum of 2-4 years experience in medical office setting required; medical terminology, and computer skills preferred.

Skills and Abilities Required:

Excellent customer service /communication skills.

Detailed knowledge of third party payer requirements for authorization requirements to facilitate payment for Imaging services.

Familiar with medical terminology, ICD-10 coding and CPT procedure codes preferred

Ability to process multiple tasks in an ever-changing environment and prioritize workload effectively. Must be able to function independently.