HEALTHCARE AUTHORIZATION / PRE-CERTIFICATION SPECIALIST

Description

Advanced Obstetrics & Gynecology in Flemington, NJ is seeking a Precertification Specialist to join our dynamic and growing practice. Our practice has 4 locations in Flemington, Lebanon and Branchburg, New Jersey.

RESPONSIBILITIES:

• This position is primarily responsible for processing all referrals, precertification and authorization requests generated by Advanced Obstetrics & Gynecology.
• Analyzes and verifies patient insurance benefits and follows up with the patient for appropriate out-of-pocket expenses.
• Communicates coverage information utilizing integrated EMR (NextGen).
• Informs patients of their insurance coverage and payment responsibilities.
• Collects payments from the patients.
• Ensure that all prior authorizations and ongoing authorizations documentation, databases and records are maintained clearly, accurately within a timely manner, and meets HIPAA requirements.
• Reviews requests made by clinicians and other authorized medical staff for additional authorized units under established guidelines.
• Initiates prior and post authorization requests via fax transmission, online submission and/or telephone contact.
• Prints outstanding patient balances for patients’ upcoming appointment.
• Works collaboratively with all team members in achieving shared goals with a consistent focus on quality care.
• Participates in quality improvement activities including data analysis, implementing recommendations, evaluating changes and outcomes.
• Responsible for the Key Performance Indicators (KPI’s) established by their manager.
• Additionally, this position provides support for the front desk staff as required and/or at the direction of the manager.
• Performs other duties as required or assigned.

Requirements

• 1 to 2 years’ experience in ambulatory/physician office setting preferred.
• Knowledge of insurance and managed care companies.
• Strong knowledge of ICD-10 diagnostic and CPT procedural code sets is necessary
• High School diploma.
• Familiarity with Microsoft Office and EMR´s preferred; NextGen experience is a PLUS
• Excellent oral and written communication skills, strong interpersonal skills, and ability to work in an autonomous/independent fashion.
• OB/GYN experience is a plus
• Excellent Attendance
• Resourceful
• Detail Oriented