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Billing Representative, Prior Authorization - Caller

POSITION SUMMARY:

The Billing Representative is responsible for requesting prior authorization in addition to verifying insurance eligibility, recording receipt of prior authorization and following up with carriers for denials, approvals and payment. In this role, the Billing Representative will also research and communicate lab testing cost estimates to patients and/or clients.

PRINCIPAL JOB DUTIES:

Duties may include but are not necessarily limited to the following:

  • Requests Prior authorization from carriers through web portals
  • Requests Benefit Investigation documentation from insurance carriers
  • Educate clients on the process to initiate Prior Authorization from carriers through web portals for testing
  • Clearly and concisely explains components of healthcare processes and terminology to clients and patients of all backgrounds
  • Verifies insurance eligibility with various government and commercial insurance carriers
  • Follows up on Prior Authorization approvals and denials in a timely manner
  • Communicates effectively with insurance carriers
  • Ensures that patient demographics, insurance information, verification and eligibility have been established and documented
  • Maintains Excel spreadsheet with patient demographics and test data
  • Provides weekly and monthly reports on productivity to management
  • Handles inbound tickets from clients regarding cost estimates for laboratory testing
  • Makes outbound calls to payers and obtains insurance coverage information and cost estimates
  • Professionally communicates information to clients and patients
  • Ensures timeliness, quality and efficiency in all work to comply with mandated, legislative, and Federal requirements
  • Meets weekly and monthly productivity standards
  • Other duties as assigned

EDUCATION:

  • HS degree or equivalent

EXPERIENCE AND REQUIRED SKILLS:

  • 2-3 years of prior authorization experience in a large healthcare, multi physician network or third-party medical billing environment.
  • Knowledge of ICD-10 and CPT-4
  • Experience using Microsoft Word and Excel or similar applications
  • Experience with insurance terminology required
  • Proficiency navigating insurance phone lines and online portals in a high volume, fast paced environment.
  • Able to read and understand claims history, denials, and payments
  • Effective verbal and written communication skills
  • Ability to successfully interface with individuals at all levels, both internally and externally
  • Excellent time management skills, great organizational skills with the ability to juggle, track, and manage all aspects of the billing process
  • Ability to work independently and in a team setting

 

BioReference Laboratories is an Equal Opportunity Employer

 



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