Impress employers and recruiters.
Choose from hundreds of resume examples.
Impress employers and recruiters.
Choose from hundreds of resume examples.
Tailor your resume to this Pre-Authorization Specialist role.
Rezi rewrites your resume against Advanced Pain Care's job description. Free.
Tailor your resume to this Pre-Authorization Specialist role.
Rezi rewrites your resume against Advanced Pain Care's job description. Free.
Don't guess if your resume is good enough.
See how it scores against the Pre-Authorization Specialist posting at Advanced Pain Care — free, in seconds.
Don't guess if your resume is good enough.
See how it scores against the Pre-Authorization Specialist posting at Advanced Pain Care — free, in seconds.
About the Role
The Pre-Authorization Specialist is responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of outpatient and ancillary services. This role involves detailed and timely communication with payers and clinical partners to ensure compliance with payer contractual requirements and accurate documentation in the patient's record.
Responsibilities
- Verifies insurance eligibility and benefit levels for services.
- Communicates with payers via electronic, telephonic, and fax methods.
- Verifies and investigates pre-certification, predetermination, and referral requirements.
- Determines medical necessity by reviewing insurance payer medical policies.
- Collaborates with clinical contacts on encounters requiring peer-to-peer review.
- Communicates with patients, clinical navigators, and financial counselors to facilitate authorizations.
- Submits clean claims and reduces payer denials by adhering to policies and procedures.
- Prioritizes workload to handle urgent cases promptly.
- Completes accurate documentation in the electronic medical record.
- Notifies payers within 24 business hours of service.
- Follows departmental policies for cases where authorization is not obtained prior to service.
- Answers questions regarding insurance authorization requirements.
- Operates standard office equipment.
- Maintains regular and predictable attendance.
- Adheres to organizational policies and procedures.
- Performs other duties as assigned.
Requirements
- Requires a high school diploma or GED.
- Minimum of three years’ experience in billing/pre-authorization or insurance verification.
- Demonstrated knowledge of health insurance plans including Medicare, Medicaid, HMO’s and PPO’s.
- Must be able to work as scheduled (typically 8:00 AM - 5:00 PM, Monday-Friday).
- Must be able to sit for prolonged periods of time.
Skills
- Insurance verification
- Benefit verification
- Pre-certification
- Authorization
- Referral requirements
- Medical necessity determination
- Medical policy review
- Electronic medical record documentation
- Payer communication
- Office equipment operation
Location
- Austin, TX
Work Type
- Onsite
- Full-time
Experience Level
- 3+ years
Education Level
- High school diploma or GED
About the Company
- Advanced Pain Care