Precertification Specialist/Check Out Desk

Precertification of all procedures and office visits as required. EXPERIENCE REQUIRED

eClinicalWorks EXPERIENCE REQUIRED.

Prioritize incoming authorization requests according to urgency

Obtain authorization via the payer website or by phone and follow up regularly

on pending cases

Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations

Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations

Fo denied authorizations, check with Dr Perofsky to see if he wants to do an appeal letter

Make appointments for patients, sending info package to patients as needed

Answers phones and assists patients as needed on phone, otherwise directs call to appropriate personnel.

Clear out fax inbox as needed

Checks patients out after office visit, collects copay and/or balance due as well as completes appropriate paperwork (consent for surgery, etc) for visit and/or surgery.

Responsible for checking eligibility, benefits and any deductible owing on all scheduled surgery patients on the first of each month or soonest possible date and scanning eligibility info into patient’s chart.

Check eligibility before all chargeable regular Medicaid, Peach State, Amerigroup and Care Source patient visits. If member is not eligible, notify member 1-2 days before visit and inform them of fee for visit.

Send out recall notices for the following month by the 10th of the current month.

Posting surgical cases in the absence of the Surgery Scheduler if needed.

Other duties as assigned.