Descripción del puesto

We are currently seeking a detail-oriented and highly organized Independent Contractor based in the Dominican Republic to support our insurance verification and authorization operations. This role is critical in ensuring timely and accurate processing of medical service authorizations and insurance verifications, while maintaining compliance with company protocols and performance standards. The ideal candidate will have strong communication skills, a solid understanding of medical terminology and insurance processes, and the ability to work independently in a fast-paced, results-driven environment.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:.

Essential Duties

• Completes accurate and timely insurance verification, comparing Diagnostic and procedures against policy provision to determined compensability of the service 
• Completes accurate and timely TAT authorization requests (evaluation of emergency or same-day/next-day services, evaluation of non-emergency or scheduled services, evaluation and negotiation of medical fees, evaluation of extensions, extended hospitalizations), including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes, UCR, number of days to be authorized complete notes) are available for the coordinators.
• Ensures services scheduled by outside providers have approved authorization as required
• and procedure prior to service.
• Prepares denial letters.
• Communicates with appropriate parties pertaining to insurance verification and authorization (point of contact for medical coordinators and account managers)
• Maintain list of admissions and complexes cases.
• Escalates financial clearance risks (big cases) to supervisors.
• Provides clear documents (notes)for clearance work according to company protocol
• Reviews admissions cases (extensions) revising and requesting discharge plans plaining, review medical necessity for level of care (LOC)
• Provides cross-coverage and training, when needed, for other team members. 
• Maintains productivity and quality performance expectations.
• Reviews and meets ongoing competency requirements of the role to maintain the

Requisitos

• Credentials in a clinical setting (doctor or nurse) from an accredited institution.
• Minimum 5 years of clinical experience.
• In-depth knowledge of insurance claims processes and regulations preferred.
• Ability to analyze and interpret medical data.
• Excellent analytical and problem-solving skills.
• Strong written and verbal communication skills.
• Ability to work independently and as part of a team.