Essential Functions

To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation:

• Schedules outpatient diagnostic tests and referrals as ordered by the providers. Documents the tests and referrals in Athena
• Maintains knowledge of insurance carrier requirements. Organizes and provides all necessary information to obtain the necessary authorization or precertification from the insurance carriers
• Works with the referring provider to resolve insurance denials or requests for additional information
• Notifies patients of their scheduled appointments. Documents their acknowledgement
• Performs other general administrative tasks as directed by the team lead
• Verifies the order with electronic and paper pre-certification data by matching reports
• Contacts insurance carriers to downgrade or upgrade pre-certs
• Reviews claim denials.
• Verifies the completeness and accuracy of coding. Use resources such as the CPT and ICD-9 provider manuals, Medicare’s Correct Coding Initiative, subscriptions, and publications to support correct coding
• Contacts insurance carriers to verify the status of claims and resolve processing problems
• Appeals claim denials as justified
• Identifies problem payers and reports them to the Assistant Practice Administrator
• Documents all insurance follow-up activity in
• Participates in educational activities
• Maintains strictest confidentiality
• Looks for trends of denials and reasons for those denials to minimize lost revenue
• Maintains and updates list of insurance carriers and companies
• Monitors changes in the insurance industry and notifies office staff of those and polices
• Performs related work as required
• Other duties as assigned.