POSITION SUMMARY:



Responsibilities include contacting insurance plans and/or authorizing agencies to obtain prior approval for scheduled surgical/ancillary events. This individual will be responsible for understanding all payer requirements and supporting the pre-certification/authorization process for all outpatient, surgical and ancillary procedures with the insurance carriers.


ESSENTIAL FUNCTIONS:


1. Work collaboratively and confidentially with support staff as well as other hospital departments, insurance carriers/authorizing agencies to obtain required pre-certification/approval for scheduled procedures.


2. Work collaboratively with health insurance carriers to verify/confirm eligibility. 3. Establish a contact network with the plans/agencies that will enable the pre-certification process to work quickly and efficiently.


4. Record all information related to approvals and denials including but not limited to the approval number, the date of the approval and name of the contact that are communicated to the provider in EPIC.


5. Communicate all pre-certification and/or authorization denials with MEE Financial Counselors and clinical areas.


6. Work closely with the physicians and their support staff to obtain the detailed information required to pre-certify a service. This includes obtaining complete registration, insurance, and the clinical data necessary for completing the pre-certification/authorization process.


7. Collaborate with support staff in situations where insurance carriers require additional clinical information such as peer to peer requests.


8. Work with Primary Care Physicians offices to obtain appropriate referrals and authorizations. Confirm this information with insurance carrier prior to the scheduled date.


9. Maintain strict confidentiality regarding all patient matters. Secure confidential information through the workday.



Qualifications

EDUCATION AND EXPERIENCE:



Minimum of three years' experience in a health care setting. Current knowledge of CPT/ICD-10-CM coding preferred. Previous experience with pre-certification/approval processes and knowledge on managed care and other health insurance polices helpful. Must possess the ability to communicate and deal effectively with patients, physicians, visitors, and peers in the course of performing job responsibilities.



EEO Statement

Massachusetts Eye and Ear is proud to be an equal-opportunity employer and is committed to providing a workplace free from harassment or discrimination. All employment decisions are made without regard to race, color, age, gender, gender identification, sexual orientation, religion, marital status, sex, pregnancy or conditions related to pregnancy, national origin/ancestry, citizenship, disability, military status, genetic information, or any other basis prohibited by law. These protections extend to all management practices and decisions, including recruitment and hiring practices, appraisal systems, promotions, training, and career development programs.