Responsible for insurance verification, pre-certification, pre-authorizations and pre-determination for CT & Vascular procedures in the ARH System. The position requires a thorough understanding of office-management software and a good working knowledge of medical/surgical clinical procedures, claims procedures and insurance company regulations. Requires accuracy, attention to detail and ability to communicate well with physicians, staff, patients and provider representatives of insurance companies.

• Assesses, obtains, verifies and documents patient’s insurance coverage and benefits to determine coverage for procedures.
• Achieve the goals and to meet the denial rates to ensure minimum loss of revenue and maximum payment for services.
• Obtains pre-certification and/or preauthorization prior to date of procedure with the goal of staying a minimum of one week ahead
• Occasionally communicates with patients their benefits and potential out of pocket exposure for procedures ordered by physicians
• Accurately documents in computer all referral pre-certification and other information relevant to a patient’s insurance coverage and financial arrangements
• Acts as a resource to staff regarding pre-certification processes
• Performs other duties as assigned.

Minimum Education

Associates degree or equivalent experience preferred.

Minimum Work Experience

One-year minimum experience working with insurance pre-certification, billing and coding preferred.

Required Skills, Knowledge, and Abilities

Knowledge of current coding for CPT/ICD9/HCPS.

Excellent organizational, communication, and medical terminology.