What are the responsibilities and job description for the Pre-Certification/Insurance and Benefits Coordinator position at Specialty Management Inc DBA Specialty...?
Job Summary:
The Precertification Coordinator & Insurance and Benefits Specialist is responsible for managing prior authorizations, verifying insurance coverage, and ensuring patients understand their benefits. This role plays a crucial part in streamlining the insurance process, securing necessary approvals, and facilitating smooth patient care.
Key Responsibilities:
Precertification & Authorization:
- Obtain prior authorizations for medical procedures, diagnostic tests, and treatments.
- Communicate with insurance companies to ensure timely approvals.
- Track and follow up on pending authorizations to avoid delays in patient care.
- Maintain accurate records of authorization approvals and denials.
Insurance & Benefits Coordination:
- Verify patients’ insurance eligibility, coverage, and benefits.
- Explain insurance benefits, co-pays, deductibles, and out-of-pocket costs to patients.
- Assist patients in understanding their financial responsibility and payment options.
- Work closely with billing and coding teams to resolve insurance-related issues.
Administrative & Communication:
- Maintain up-to-date knowledge of insurance policies and changes.
- Serve as a liaison between patients, providers, and insurance carriers.
- Document all communication with insurance companies and patients in the system.
- Provide support in resolving claim denials related to authorization issues.
Qualifications & Skills:
- High school diploma or equivalent required
- Experience in medical insurance verification and prior authorizations (minimum 1-2 years preferred).
- Strong understanding of medical terminology, CPT codes, and insurance guidelines.
- Excellent communication and customer service skills.
- Ability to multitask, stay organized, and work in a fast-paced environment.
- Proficiency in electronic health records (EHR) and insurance portals.
Work Environment:
- Office-based position within a medical practice.
- Regular interaction with patients, insurance companies, and healthcare providers.