Pre-Certification Specialist

Job description

Job DetailsJob Location: Albuquerque, NM 87110 POSITION SUMMARY: Responsible for timely verification of benefits and prior authorizations for all physicians and physical therapists. ESSENTIAL RESPONSIBILITIES: Updates and maintains patient demographics as needed. Verify eligibility of benefits from the provider’s schedule, real time, 3 days prior to scheduled appointments. Review credentialing for accuracy and contract information. Verify referrals if needed and obtain referral from PCP. Obtain eligibility and prior authorizations for DME, assigned surgeries and outside testing and physical therapy. Coordinate with Front Office, Medical Records, Medical Assistants and Account Representatives on above data. Maintains files with insurance authorizations and referral information. Assist in covering team member’s work, when others are out. Works overtime hours as needed. Adheres to company policies as described in employment handbook and company work rules. Participates in professional development activities and opportunities. Attends staff meeting and others as required. Maintains confidentiality of patient account information in accordance with HIPAA guidelines and NMOA policy. Regul...