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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing insurance claims, including prior authorizations and medical necessity determinations, while effectively communicating with patients regarding coverage. Proficient in utilizing ICD-10 and HCPC coding for accurate claim submissions in a fast-paced healthcare environment.
Highest-signal resume keywords
Insurance VerificationICD-10 CodingPrior Authorization ProcessingReferral ManagementCollections Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim SubmissionMedical Necessity DeterminationService Estimates PreparationPre-Service Payments CollectionDME Experience
Soft Skills
Communication SkillsAbility to Work in Fast-Paced Environment
Certifications & Qualifications
LPNMedical SecretaryHealth Unit CoordinatorMedical AssistantParamedicEMTPharmacy Tech
Industry Keywords
HealthcareHealth PlanPre-Service AuthorizationsWorkers' CompensationPopulation Health
About the role
Key responsibilities & impact- Gather necessary insurance information
- Translate patient/guarantor information into the computer system for accurate claim submission
- Verify insurance
- Select ICD-10 or HCPC codes
- Process prior authorizations and pre-certifications
- Determine medical necessity
- Process referrals and workers' compensation authorizations
- Prepare service estimates
- Communicate with patients when services are not covered
- Collect pre-service payments
Requirements
What you’ll need- Pre-Service Authorizations Coordinator: 1-year experience in a healthcare or health plan setting, ability to work in a high volume/fast-paced environment, referral and authorization knowledge, or meets the listed educational requirements
- Pre-Service DME Coordinator: 1-year DME experience or meets the listed educational requirements
- Pre-Service Financial Coordinator: 1-year collections experience and experience with pre-service or financial counseling, or meets the listed educational requirements
- Population Health Authorization Coordinator: 1-year experience in a healthcare or health plan setting, ability to work in a high volume/fast-paced environment, referral and authorization knowledge, or meets the listed educational requirements
- For Pre-Service Authorizations Coordinator only: graduate of an LPN, Medical Secretary, Health Unit Coordinator, Medical Assistant, Paramedic, EMT, Pharmacy Tech, General Associate Degree program, or similar
- Day rotation availability
- Work authorization/location: Brainerd, Minnesota, United States
Benefits
Comp & perks- Medical, dental, vision, life, and disability insurance
- Supplemental insurance options
- 401(k) plan with employer contributions
- Professional development through training, tuition reimbursement, and educational programs
- Flexible scheduling
- Generous time off
- Wellness resources focused on physical, mental, and emotional health