INSURANCE, PRE-CERT SPECIALIST

Insurance, Pre-Certifications Specialist

Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. We are seeking qualified, like-minded individuals to join our team!

RESPONSIBILITIES:

• Basic knowledge and understanding of various insurance plans
• Understanding of the Insurance Approval, Denial, and Appeals processes
• Basic knowledge of Waystar, Availity, etc. 
• HIPAA knowledge and compliance
• Read and understand Physician Order Forms
• Research insurance coverage and accurately interpret patient benefits for all diagnostic and non-surgical procedures.
• Review practice and insurance company guidelines to ensure prior approval requirements are met. Present any necessary medical information such as history.
• Validate insurance eligibility and benefits via phone and/or the internet.
• Enter complete and accurate patient data in the EMR system, including patient demographics and current insurance information.
• Notify departments of any issues prior to the patient scheduled.
• Answer pre-cert questions
• Update patient insurance information
• Communicate with Procedure Schedulers on a regular basis
• Answer patient questions regarding insurance
• Navigate insurance websites
• Scan and index documents

KNOWLEDGE/ABILITIES/EXPECTATIONS:

• Promote the mission, vision, and values of Galen Medical Group.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Report to work on time and as scheduled.
  • Some weekends, holidays, and overtime may be required.
• Represent the organization in a positive & professional manner.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
• Comply with all organizational policies and standards regarding ethical business practices.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services as directed by your manager.
• Consistently demonstrate the value of a team concept.
• Ability to manage multiple and simultaneous responsibilities.
• Complete assignments efficiently and in a timely manner.
• Understand and abide by OSHA, HIPAA & CLIA standards.

The above job description is intended to describe the general content of and requirements for this job. It is not intended to be a complete statement of duties, responsibilities, or requirements.

QUALIFICATIONS:

Education:

• High school graduate or equivalent

Experience

• 1-year minimum pre-certification and insurance verification experience
• Understanding of CPT and ICD-10 coding
• Surgical billing/coding experience preferred

Skills:

• Commitment to excellent customer service
• Excellent written and verbal communication skills
• Ability to prioritize and manage multiple responsibilities
• Good judgment and strong critical thinking skills
• Excellent problem-solving
• Able to take and follow through with delegated tasks and accountability

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patients needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patient's needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.