PreCertification Representative

Medix is seeking an experienced precertification representative. This is an onsite, contract to hire position.

This position is responsible for confirming and satisfying all authorization billing requirements by obtaining the appropriate precertification/authorization from all necessary payers to avoid delays in treatment/payment penalties. Responsible
to confirm the financial/insurance information obtained during the registration process to determine that State, Federal and Third Party precertification/billing requirements are met to ensure optimal reimbursement for services to be
rendered.

Job Responsibilities

• PreCertification reviews and verifies scheduled services utilizing appropriate clinical/registration systems and ensures that all authorization/precertification requirements are completed and available.
• Reviews the patient record to determine completeness of the information gathered to ensure it is complete based upon Federal and Third Party billing requirements.
• Verifies medical insurance coverage including effective dates to determine and facilitate all precertification and, authorization requirements.
• Pre-certify outpatient procedures and radiology services as required by insurance companies for scheduled appointments & in office procedures.
• Monitors reports/work lists to ensure all scheduled patient hospital services are reviewed/authorized prior to service delivery.
• Follows up with insurance companies and providers to obtain resolution of authorization/denial issues.
• Notify payers of inpatient admissions when necessary.
• Communicates to registration, billing and physicians concerning authorization/pre-certification/referrals when necessary.
• Appropriately refers patients requiring financial counseling.