Join a compassionate team dedicated to ensuring smooth patient access and insurance verification in a supportive healthcare environment located in the Central Plains region of the United States. This role focuses on identifying insurance coverage, obtaining necessary pre-certifications, and assisting with referral data entry to promote positive outcomes for patients and the agency.

Key Responsibilities

• Verify insurance eligibility and benefits accurately.
• Obtain pre-certifications and ongoing authorizations from various insurance providers.
• Support intake and referral processes to ensure timely patient care and optimal staffing.
• Maintain up-to-date knowledge of federal, state, and private reimbursement regulations, including CMS guidelines.
• Participate in audits and data submissions required by insurance and regulatory bodies.
• Ensure compliance with certification, PPOC, and Face-to-Face requirements.
• Conduct audits of admissions and patient records for quality reporting and program-specific conditions.
• Complete pre-billing and performance improvement chart audits as assigned.
• Maintain clear and timely documentation in accordance with agency policies.
• Foster effective communication and cooperation with physicians, staff, and clients to support reimbursement processes.
• Perform clerical duties such as managing phone calls and processing incoming faxes.
• Adhere strictly to HIPAA regulations regarding Protected Health Information (PHI).

Education

• High School Diploma required.
• Associate’s or Bachelor’s Degree in Health Care or Business preferred.

Experience

• Medical office experience and knowledge of medical terminology preferred.
• Experience with insurance authorization processes is a plus.

Skills and Requirements

• Advanced computer skills, including proficiency with medical record systems and Microsoft Office.
• Strong communication abilities and keyboarding skills.
• Valid driver’s license and proof of auto liability insurance as required by state regulations.
• Demonstrated integrity, compassion, accountability, respect, and excellence in customer service.
• Ability to work independently and adapt to changing priorities.

This position offers a competitive salary and a generous benefits package, providing a meaningful opportunity to contribute to patient care in a regional healthcare setting.