|Location|| ||160 Macgregor Pines Drive|
160 MacGregor Pines Drive
Cary, NC 27511
|Employee Type|| ||Regular Full-Time|
|Job Category|| ||Bariatric Insurance |
|Industry|| ||Health Care|
|Minimum Experience|| ||6 Years|
|Required Degree|| ||2 Year Degree|
|Manage Others|| ||Yes|
|Name|| ||Donalyn Miller|
- Reviews and submits necessary patient information to insurance companies for preauthorization for surgery. Follows progress of preauthorization process to ensure timely turnaround.
- Maintains patient contact throughout the preauthorization process.
- Reviews insurance denials. Resubmits with required documentation as appropriate. Manages appeal process. Schedules and manages peer-to-peer reviews with Bariatric Surgeon and Insurance MD Reviewer as required.
- Researches insurance policies and procedures as pertaining to the bariatric surgical process. Keeps knowledge of insurance policies and procedures up to date and current. Informs staff and management of any updates/changes as appropriate.
- Schedule peer to peer consultations for the providers with insurance companies.
- Review clinical documentation to ensure accuracy of procedure being performed and update necessary changes.
- Able to research and analyze insurance policies, CPT codes and diagnosis codes
- Update patient status flow in Athena
- Instruct patients on pre surgery instructions as needed
- Submit/Guide patients when necessary through insurance appeals
Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Must have strong attention to detail, solid communication/follow up skills, and the ability to work well under deadlines. Demonstrated computer proficiency using Windows applications and MS office programs required.