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Full time @rcmjobs in Approvals
  • Post Date : November 28, 2022
  • Apply Before : March 1, 2023
  • Salary: Rs30,000.00 - Rs40,000.00 / Monthly
  • 0 Application(s)
  • View(s) 9
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Job Detail

  • Job ID 2028
  • Career Level Coder
  • Experience 2 Years
  • Industry Healthcare-IT
  • Qualifications Bachelor's Degree
  • Certifications CPB

Job Description

  • Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt, pt estimation calculation
  • Successfully works with payers via electronic / telephonic and / or fax communications.
  • Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services
  • Coordinates and supplies information to the review organization (payer) including medical information and / or letter of medical necessity for determination of benefits.
  • Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
  • Communicates with clinical partners, financial counsellors  (Pt estimation), and others as necessary to facilitate authorization process.
  • Facilitates submission of clean claims and reduction in payer denials by adhering to both organizational and departmental policies and procedures and maintaining departmental productivity and quality goals.
  • Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation in both the Auth / Cert and Referral Shells.
  • Completes notification to all payers via electronic / fax / telephonic means within 24 business hours of service to ensure compliance with Managed Care contractual requirements.
  • Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
  • Follows departmental policies and procedures when necessary authorization is not obtained prior to service date.
  • Answers provider, staff(prognosis messages), and patient (email from CM, PFS) questions surrounding insurance authorization requirements.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
  • Communicate any insurance changes or trends among team.
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
  • Denial management, finding trends / Medical policies beneficial for pre-auth process / Identify and report trends and prior authorization issues relating to billing and reimbursement.
  • Performs other related duties as required or assigned.


Required skills

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