Medical Pre-Authorization Clerk
- Vision , Medical , Dental , Life Insurance , Retirement
The Medical Pre-Authorization Clerk role is a dynamic position on the front lines of serving our patients that requires multi-tasking, communication, and teamwork. We are a very busy practice and are looking for someone who is a fast learner, detail-oriented, can work under pressure, and will be a valued addition to our team. COVID-19 vaccination required.
Responsibilities and Duties
- Calls insurances and pharmacies for pre-authorizations and schedules peer-to-peers, as necessary.
- Verify coverage, benefits and eligibility for the patient with insurance company
- Pre-Cert / authorization for upcoming surgeries with insurance company
- Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
- Monitors e-fax, fax machines, and mail for authorization/re-authorization requests and routes information timely to the appropriate individuals for processes.
- Answers inquiries from patients and providers and routes to appropriate physician.
- Communicate authorization information to patients accurately and in a timely manner.
- Effectively resolves inquires related to status of authorization requests.
- Provides accurate and timely documentation to physicians for peer-to-peer consultation.
- Use hospital or provider systems to locate appropriate patient details.
- Respond to requests with the corresponding health information.
Qualifications and Skills
- Previous pre-authorization experience required
- Previous medical office experience - strongly preferred
- Knowledge of medical terminology - strongly preferred
- Knowledge of HIPAA - required
- Provide excellent customer service, including compassion, ability to assess situations, identify concerns, and give timely follow up
- Display a courteous and professional manner through interaction, appearance, attitude, and with written and oral communication with patients, third parties, co-workers, and physicians
- Ability to protect and maintain the confidentiality of patient’s medical records and patient information, handling patient information with discretion and integrity
- Ability to work efficiently in a fast paced, unpredictable (at times) environment
- Strong organizational skills, time management, and multi-tasking abilities
- Meticulous attention to detail
- Proficient data entry skills
- Strong computer skills, with ability to quickly master new systems and software, including EMR
- Must be able to effectively use office technology, such as fax, copier, and scanner
- High school graduate – required
- Medical office pre-authorizations/clinical/records administration: 2 years required
- High school
Required work authorization:
- Authorized to work for any employer in the United States
Northern Virginia Pelvic Surgery Associates PCFairfax, VA
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