St. Margaret’s Health – Peru
Monday through Friday, Days
Scope of Responsibility:
Responsible for contacting payers by phone or online for patient benefits and pre-certification/authorization for outpatient services; Coordinate information with physician offices and internal departments pertaining to pre-certification/authorization of services. Knows Medical Terminology and ability to read physician charting and communicate information to insurance company. Responsible for verifying that physician orders are complete and that the diagnosis provided and the testing ordered meet Medicare’s Local Coverage Determinations and/or private insurance requirements prior to services being performed; Knowledge of scheduling process and procedures; Able to utilize resources for coding procedures and diagnosis; perform follow up on pending authorization; accurately performs mandatory documentation of approval or denial of procedure and notify scheduling of outcome.
Minimum high school diploma or equivalent.