Job Summary
The Senior Officer – Insurance Pre-Authorization will secure pre-approvals for all contracted payers and assist patient with insurance coverage.
Job Responsibilities 1
Studies insurance plans used most frequently with patients to understand the various nuances to communicate more effectively.
Documents basic insurance information in the patient’s file for quick reference.
Processes and submits insurance claims daily.
Monitors and follows up on outstanding claims.
Provides the appointment coordinator with patient names and amounts due, so effective collection over the counter can take place during the day.
Identifies patients in the daily schedule who are a financial concern, notes payment problems on the patient’s chart, and arranges a conference with them either before or at the time of the appointment.
Records all financial discussions with patients in their file.
Contacts patients who have not kept their financial agreement within a 5-day grace period to collect payment following the financial plan.
Prepares and mails patients’ statements each month on a regular billing cycle.
Sends information as requested by insurance companies such as x-rays, charting, narratives, and other documentation for processing the claim when applicable.
Provides insurance predetermination documentation to patients, contacts the patient to make financial arrangements, and schedules treatment.
Corresponds with insurance companies to resolve payment delays, requests for additional information, or to discuss denied treatment coverage.
Job Responsibilities 2
Handles all inquiries concerning insurance daily.
Contacts physician’s office to obtain current prescriptions and clinical documentation that is required by the plans.
Validates that the clinical documentation received is what is required by the plan.
Follows up on all pending PA’s within 48 hours.
Responds to urgent requests in a timely manner.
Submits all new Complex authorization approvals and/or Complex re -authorization approvals through the Complex audit process.
Initiates re-authorizations that are set to expire 30 days prior to the term date.
Job Knowledge & Skills
Proficient in all Microsoft Office applications as well as medical office software.
Sound knowledge of health insurance providers.
Deep knowledge of Revenue Cycle Management within Billing, Collections, and Remittance posting.
Ability to work in a fast-paced environment.
Billing/Coding certification(s) preferred but not required.
Knowledge of payer websites, processes, local, state, and federal requirements
Job Experience
Minimum 2 years of experience in healthcare (required).
Proven experience in healthcare billing.
Minimum 1 years’ experience with data analytics (required).
Minimum 2 years of experience in GCC (preferred).
Competencies
Accountability
Collaboration
Leadership
Quality
Resilience
Education
Bachelor's Degree in Nursing or Science
Certificate in any related field
Power International Holding (PIH) is a diversified business conglomerate, grouped into 5 main sectors: General Contracting, Agro-Food Industries, Real Estate Development, Lifestyle (Hospitality, Entertainment & Catering) and General Services. To ensure the sustainability and success of each businesses within the various sectors, we are committed to providing every entity with the tools and resources together with the central functional support to enable development and growth. We work in specialization, to ensure that each business strives to achieve the organization’s objectives and goals. Grouping is done through focus and trade excellence of organization leaders who proactively work together in multi-disciplinary groups, ensuring that each business thrives and flourishes.
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