Insurance Pre-Auth Spec I

Job description

Min USD $16.50/Hr. Max: USD $24.82/Hr. Overview: The Insurance Pre-Authorization Specialist I is responsible for completing prior authorizations, pre-certifications, and notifications for third-party and government payers across all pre-scheduled elective inpatient admissions, direct admits, emergency room admissions, and outpatient procedures. This role requires a thorough working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan utilization. The specialist coordinates with third-party payers, physicians, nursing staff, and other healthcare providers to ensure all prior authorization and pre-certification requirements are met in accordance with payer guidelines. This includes providing education and direction to clinical and administrative staff regarding authorization processes and payer-specific requirements to support accurate and timely reimbursement. This position is responsible for tracking, documenting, and monitoring authorization and pre-certification status throughout the continuum of care. The specialist also performs dynamic coding for outpatient services and urgent admissions by correlating and documenting acc...