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- Responsible for obtaining prior approval/precertification from patient' insurance company for surgical, MRI, PT/OT, DME and any other services.
- Verifies patient insurance information utilizing the RealMed system.
- Obtains prior approval for services via telephone, facsimile or internet.
- Verifies in-network and out-of-network coverage levels for services.If an out-of-network service follows out-of-network protocols and coordinates services with hospital(s).Refers patients with out-of-network coverage to Financial Coordinator to discuss payment options.
- Coordinates all documentation required for precertification of services including, but not limited to the medical record, pre-operative reports, and Letters of Medical necessity.Is familiar with the general surgical procedures performed by each physician.
- Requests assistance from manager or physician office if additional clinical information is required.Requests necessary documentation from each physician.
- Notifies physician office and/or patient when services are not approved.Knows process and protocols for appealing precertification decisions.
- Keeps records of phone calls.Notes name of contact, phone number and any required reference numbers.
- Contacts insurance companies and third party administrators in a timely fashion.Is able to organize and prioritize work-flow based on the needs of each physician office.
- Works well with and responds promptly to requests by Physicians, physician secretaries and other staff.
- Utilizes professional telephone conduct at all times.
- Stays abreast of and complies with all state and federal laws including HIPAA, ADA, OSHA, and FLSA.
- Understands that the mission of Midwest Orthopaedics at RUSH is to meet patient needs and provide the patient with highest level of medical care.
- Adapts to change in a positive and professional manner.
- Answers patients' questions regarding statements and insurance coverage.
- Other duties may be assigned.
- High school diploma or general education degree (GED)
- Minimum of one year work experience, preferably in a medical office setting
Precertification Coordinator - Westchester, United States - Midwest Orthopaedics at Rush
Description
It's the people that make the difference.Are you ready to make your impact?Midwest Orthopaedics at Rush is nationally recognized as a leader in comprehensive orthopedic services.The Orthopedic Program at Rush University Medical Center is ranked Top 10 in Orthopedics by U.S. News and World Report.Founded in 2003, MOR is comprised of internationally-renowned Orthopedic and Spine surgeons who pioneer the latest advances in technology and surgical techniques to improve the lives and activity levels of patients around the world.MOR doctors are the official team physicians for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club and DePaul University Athletics.
Ready to join in? We are looking for a Precertification Coordinator to be based at the corporate office near Oak Brook, IL. Candidate will be responsible for obtaining prior approval/authorization from insurance companies. The ideal candidate must have excellent customer service skills, computer skills, as well as strong communication skills both verbally and written. This position is a full-time, work from home opportunity, the candidate will need to be flexible to come into the office as needed.
Essential Duties and Responsibilities include the following. Other duties may be assigned.