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Precertification Specialist - Center for Orthopaedics
This position is: Full Time
Position Location: Lake Charles, LA

GENERAL SUMMARY OF DUTIES:

The purpose of this position is to obtain pre-authorization from insurance companies based on the patient's benefits on all surgeries and procedures prior to the date of service.

SUPERVISION REQUIRED: Reports to assigned team leader, department/practice manager.

ESSENTIAL FUNCTIONS:

  1. Responsible for assuring appropriate insurance verification, prior approvals, and all authorization requirements are obtained prior to the patientís arrival for surgery or procedure.
  2. Communicate with physicians, mid-level providers, and clinical staff as needed to obtain and understand clinical documentation requirements.
  3. Provide required clinical documentation to payers via phone, faxed forms, and/or website
  4. Responsible for relaying an estimated cost of treatment.
  5. Ability to multi-task prioritize and remain focused with a high-volume and time sensitive workload.
  6. Contact referring providers both internal and external as needed.
  7. Clearly document authorization approvals and denials in Practice Management systems including authorization numbers and associated codes, dates, and other relevant data.

KNOWLEDGE:

  1. Knowledge of CPT and ICD-10 terminology preferred.
  2. Basic knowledge of managed care needed.
  3. Basic computer knowledge, typing and 10-key skills needed.
  4. Previous knowledge of insurance is helpful.
  5. Previous medical terminology helpful.
Requirements:

EDUCATION:

High school diploma or equivalent

EXPERIENCE:

  1. Moderate level of computer skills including EMR (electronic medical record) systems, Practice Management system, basic office applications including Outlook, Word, Excel and use of the internet is preferred.
  2. Customer service experience; preferably in healthcare related environment is preferred.
  3. Medical billing experience and pre-cert experience is preferred.

 

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