Pre-Authorization Medical Specialist

Pre-Authorization Medical Specialist – Full-Time ON SITE

Great opportunity to join an amazing medical practice in Monmouth County, New Jersey. The Pre-Authorization Representative is responsible for ensuring verification of insurance information, plan benefits and pre-certification requirements, and documents patient’s financial obligation prior to scheduled appointment. Also responsible for obtaining prior authorization from payers for services provided by this medical office.

Responsibilities :

• Work closely with referring physicians and payors to ensure authorization for the patient’s procedure is obtained prior to the patient’s appointment.
• Input proper corrections and document all relevant information in system as needed.
• Contact patient to schedule procedure, inform patient of instructions for the procedure and any additional relevant instructions.
• Effectively handle and troubleshoot authorization denials following established protocols.
• Communicate all challenges, potential impact the challenge may have on the department and possible solution(s) to the management team.
• Review patient’s insurance information and eligibility for services.
• Verify pre-certification and referral requirements are needed prior to services.
• Document patient financial obligation; copays, coinsurance, deductible, self-pay etc.
• Communicate with insurance companies, referring physicians, and / or patients to verify insurance eligibility and pre-authorization status as needed.
• Re-schedule patients as needed
• Demonstrate ability to keep abreast of regulatory and insurance requirements ensuring that changes are incorporated in daily job functions.

Qualifications :

Salary determined upon skills and experience

Experience :