Our TeamOur employees make a difference in the lives of our patients and our community. We've built a culture of excellence based on compassion, care and collaboration. At EPGI, our goal is for an inclusive and engaging employee experience where people feel they belong and their work matters. We offer competitive pay to motivate and retain the best talent, and a full range of benefits to our employees.Our PracticeWhether a patient is experiencing GI symptoms for the first time, or have been previously diagnosed with a disease of the digestive system, Eastern Pennsylvania Gastroenterology and Liver Specialists (EPGI) and our highly trained, board-certified physicians and staff are able to address our patient needs with the most up to date treatment options and perform the most state-of-the-art procedures with compassion and care.Our practice is currently seeking a full-time Payment Posting Specialist to join our team!Job Title: Precertification SpecialistDepartment: Precertification Department/ Billing DepartmentImmediate Supervisor Title: Billing ManagerJob Supervisory Responsibilities: NoneGeneral Summary: This position collaborates with physicians and provider office staff directly in ascertaining the appropriate authorization based on medical necessity and the treatment plan provided. Verify/obtain additional clinical information and insurance authorizations/referrals. Communicates direct/indirect with insurance companies to obtain insurance verification and precertification for approval. The Precertification Specialist is also responsible for the verification of eligibility and benefits of medical insurance, documenting the information into the software system and communication of patient liability to the patient and providers.Essential Job Responsibilities:Review scheduled appointment charts to determine need for referral * Check practice management system for evidence of current referral
Contact patients to remind them of referrals
Contact primary care physician office to obtain referral copies
Obtain pre-authorization for scheduled radiology and endoscopic proceduresAbility to handle phone calls from patients, insurance companies, other providers, and health care facilitiesAbility to accurately enter all referrals into the practice management systemAbility to check insurance web sites for referral copies
Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to services being rendered.
Successfully works with payers via electronic/telephone 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 patients, clinical partners, insurance companies, and others as necessary to facilitate authorization process.
Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
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, and patient questions surrounding insurance authorization requirements.
Assist in billing department overflow when necessary
Education: High School diploma/GEDExperience: Minimum one year of experience in a medical practice settingPreferred Qualification Requirements:Knowledge: * Specialized training in insurance, coding, billing or similar healthcare certificate programs
Experience in outpatient billing/pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Commercial HMO and PPO required.
Prior experience in a business office position with strong customer service background preferred.
Knowledge of basic medical terminology
Knowledge of practice management, hospital and insurance site computer systems
Skills: * Knowledge of computer systems
Knowledge of web sites associated with the job (i.e. insurance sites)
Bi-lingual in English and Spanish is a plus
Abilities: * Maintain composure when confronted with fast paced and stressful situations
Demonstrate willingness to adapt to change
Attention to detail
Good organization/time management skills
Knowledge of medical terminology
Ability to communicate effectively, both orally and in writing
Email communication experience
Self-starter
Ability to prioritized workload and multi-task
Ability to follow instructions and meet deadlines
Equipment operated:Computer hardware/software including Practice Management and Electronic Medical Record softwareWork Environment:Office setting, well lighted. Good air quality. No direct, face-to-face contact with patients.Mental & Physical Requirements:Mostly sedentary with some standing, walking, reaching, bending, pushing and lifting up to fifteen (15) pounds.