Insurance Pre-Certification Clerk - Full-time / Part-time

Contacts Medicare, BlueCross BlueShield and other payers daily. Verifies the ODC 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. Reviews previous imaging reports and creatinine lab reports for studies such as CT and MRI performed at SoFHA, MSHA, and other outside entities. Follows up on unpaid carrier claims according to the balance and age of the charges. 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 Front Office Supervisor and ODC Imaging Director. Documents all insurance follow-up activity in IDX 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.

PERFORMANCE REQUIREMENTS : Knowledge, Skills, and Abilities: Knowledge of medical business office procedures. Knowledge of the insurance policies accepted by the practice and referral and precertification procedures requirements typically associated with each. Knowledge of medical terminology, human anatomy, appropriate facility to schedule procedures with, ICD-9 and CPT coding. Skill in using a computer. Knowledge of grammar, spelling and punctuation. Ability to read, understand and follow oral and written instructions. Ability to speak clearly and concisely. Ability to establish and maintain working relationship with patients, employees and the public.

EDUCATION AND EXPERIENCE: High school diploma or GED.
Experience: One-year general clerical experience, preferable in a medical office setting. Word processing and computer experience. Familiarity with local insurance policies and their referral requirements. Certificate / License: None
ALTERNATIVE TO MINIMUM QUALIFICATIONS: Additional appropriate education may be substituted for one year of clerical experience.
MINIMUM PHYSICAL REQUIREMENTS: Requires working in office environment. Requires sitting for long periods of time with some bending and stretching required. Manual dexterity required for use of computer keyboard. Requires working under stress. Vision must be correctable to 20 / 20 and hearing must be in normal range for patient contact.

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About Advantage Resourcing

Advantage Resourcing is committed to providing equal employment opportunity for all persons regardless of race, color, religion (including religious dress and grooming practices), sex, sexual orientation, gender, gender identity, gender expression, age, marital status, national origin, ancestry, citizenship status, pregnancy, medical condition, genetic information, mental and physical disability, political affiliation, union membership, status as a parent, military or veteran status or other non-merit based factors. We will provide reasonable accommodations throughout the application, interviewing and employment process. If you require a reasonable accommodation, contact us. Advantage Resourcing is an E-Verify employer. This policy is applicable to all phases of the employment relationship, including hiring, transfers, promotions, training, terminations, working conditions, compensation, benefits, and other terms and conditions of employment.

All employees are directed to familiarize themselves with this policy and to act in accordance with it. All decisions with respect to employment matters and other phases of employer-temporary employee relationships will be in keeping with this policy and in accordance with all applicable laws and regulations.