Pre Certification Clerk

Rockville, MD
Oct 01, 2021
Nov 15, 2021
Administrative, Other
Full Time
Job Summary/Company:
Sparks Group has partnered with a leading medical organization to perform critical medical billing. This role will support a large hospital systems Imaging Department. If you have strong communication and have worked with patient scheduling then apply today!!

Major Responsibilities:
Request pre-authorization and obtaining clinical notes (if necessary), to obtain the pre-authorization for patients to receive imaging services:
• Pre-Registration
• Insurance Eligibility / Benefit Verification
• Service Authorization
• Dedicate time to obtaining clinical information required to start precertification requests
• Patient Liability Estimation
• Communicate with patient on authorization status via different communication methods to assure the message has been received
• Communicate to offices and/or manager about status of authorizations is unable to reach the patient
• Enter relevant information in the comment section to maintain accounts up to date
• Obtain Stat authorizations as needed
• Down-code and up-code authorizations upon request
• Ability to be flexible and cover other sites when staff team members are on PTO
• Responsible for filling gaps left on schedule due to rescheduling of appointments (cause by authorization denials and/or rescheduled)
• Request assistance from supervisor for patients who need exams and authorizations are not ready
• Special projects as assigned by supervisor
• Other duties as assigned

This role will require a team player who will be dedicated to insurance authorizations and pre-registration for scheduled visits. It requires collaboration with physicians, case manager/nurses, and insurance companies as well as other internal partners and stakeholders to assure quality services are rendered.

Obtains authorization/pre-certification for the correct scheduled exams of assigned facility.
Effectively uses task work list and inputs insurance benefits and authorizations in the proper context and location.

Schedules and reschedules patient appointments when needed from the scheduling phone queue or incoming phone calls.

Maintains patient confidentiality and complies with HIPAA guidelines.

Performs related work as required.

Positive and courteous customer Service.

Other Skills/Experience
o Candidates with prior clinical education and experience are preferred
o Medical Terminology, Radiology experience preferred but not required
o Ability to maintain a professional attitude when speaking with payers, vendors and agencies representing
o Current knowledge in insurance protocol
o Basic PC skills (such as Windows, Microsoft Office Suites)
o Excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
o Ability to use standard office equipment

Education /Qualifications /Experience
o High school diploma or GED equivalent
o 1-2 years medical office experience preferred
o 1-2 years customer service experience preferred
o Medical terminology or radiology terminology background
o Ability to maintain a professional attitude when speaking with payers, vendors, and agencies representing
o Current knowledge of insurance protocol
o Basic PC skills such (e.g. Windows, Microsoft Office)
o Must be able to type a minimum of 35 w.p.m.
o Ability to use standard office equipment (i.e. copier, fax, printer)
o Excellent customer service skills
o Spanish Speaker preferred

Physical and Mental requirements:
o Constantly operates a computer and other office equipment to coordinate work
o Usually remains stationary for most of the day
o Frequently communicates with clients and coworkers and must be able to share information effectively.
o Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
o Generally, works in an office environment

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Qualified candidates should send their resume AND call Sparks Group for additional details. Please note, resume must include a valid email address in order to be considered. We look forward to discussing your background, your current job search, and your potential career path with Sparks Group!

Sparks Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, pregnancy, citizenship, family status, genetic information, disability, or protect veteran status.

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