What are the responsibilities and job description for the Precert Referral Clerk Occupational Health Clinic Full Time position at Carolina Pines Medical Group?
Description
Summary
- The Pre-Cert and Referrals Clerk is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers
Essential Functions
To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation:
- Schedules outpatient diagnostic tests and referrals as ordered by the providers. Documents the tests and referrals in Athena
- Maintains knowledge of insurance carrier requirements. Organizes and provides all necessary information to obtain the necessary authorization or precertification from the insurance carriers
- Works with the referring provider to resolve insurance denials or requests for additional information
- Notifies patients of their scheduled appointments. Documents their acknowledgement
- Performs other general administrative tasks as directed by the team lead
- Verifies the order with electronic and paper pre-certification data by matching reports
- Contacts insurance carriers to downgrade or upgrade pre-certs
- Reviews claim denials.
- Verifies the completeness and accuracy of coding. Use resources such as the CPT and ICD-9 provider manuals, Medicare’s Correct Coding Initiative, subscriptions, and publications to support correct coding
- Contacts insurance carriers to verify the status of claims and resolve processing problems
- Appeals claim denials as justified
- Identifies problem payers and reports them to the Assistant Practice Administrator
- Documents all insurance follow-up activity in
- Participates in educational activities
- Maintains strictest confidentiality
- Looks for trends of denials and reasons for those denials to minimize lost revenue
- Maintains and updates list of insurance carriers and companies
- Monitors changes in the insurance industry and notifies office staff of those and polices
- Performs related work as required
- Other duties as assigned.
Qualifications
Education
- High School or GED required
- Post high school vocational or specialized training preferred.
Experience
- 2 years medical prior authorization/referrals experience preferred
- 2 years of experience in a medical related field required
- Requires critical thinking skills, decisive judgement, and the ability to work with minimal supervision
- Must be able to work in a stressful environment and take appropriate action
