Insurance Review- Patient Access, FT

This position is responsible for timely contact of third party payer to determine and verify benefits and pre-certification requirements for admissions, observations, and outpatient services.  Initiates the pre-certification process within the timeframe designated by the third party payers.  Documents benefits and pre-certification requirements in the hospital information system.  Works in collaboration with the case managers, discharge planner, Business Office and ancillary departments as needed.  Processes appeals for all patient types. Track and trend denials due to lack of prior authorization. Adheres to organizational policies and procedures; regulatory/ accrediting body requirements; and professional practice standards.

Requirements Include: 
  • High school diploma or equivalent

  • Working knowledge of the rules and regulations of governmental payers

  • Working knowledge of contractual requirements for third party payers

  • Working knowledge of ICD-9, CPT coding and medical terminology

  • Working knowledge of Registration, Central Scheduling and Quality functions

  • Previous experience in related field preferred

Job Specifics
Patient Access
Average Weekly Hours: 
Employment Specialists
Phone Number: 
E-Mail Address:
Posting Date: 
Thursday, March 14, 2019