Surgical Insurance Specialist/Benefit Investigator

Freehold, Full time

Responsibilities:

·         Verify patients insurance benefits, inform/educate patients on referrals needed, deductibles and coinsurance information based on the patients plan.

·         Use phone or computer to communicate with insurance companies to obtain authorizations or predeterminations.

·         Obtain precertifications from insurance companies for a variety of surgical procedures including, but not limited to, cataract surgery, corneal procedures, glaucoma surgeries and lasers.

·         Follow through on precertifications until final approval is obtained.

·         Proper documentation of obtained precerts in EMR system.

·         Submitting clinical data as requested by insurance companies for precertification, either through fax or online portals.

·         Understanding medical terminology to be able to answer clinical questions after reviewing chart notes.

·         Submitting appeals through insurance companies in the event of denials of prior authorizations or denials of payment following procedures. Set up peer to peer calls as needed with providers and insurance companies.

·         Manage faxes, emails, and phone calls in a timely manner. Respond to voicemails and emails within the same day.

·         Communicating with surgical coordinators regarding authorizations or denials prior to surgical dates. Also, communication with the surgery center billing offices in regards to authorizations needed.

 

Qualifications:

·         Precertification/insurance experience a plus.

·         EMR/medical office experience

·         Knowledge of medical terminology (ophthalmology preferred)

·         ICD 10, HCPCS and CPT code knowledge

·         Excellent written and verbal communication skills

·         Organization skills with attention to detail

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