|Precertification Specialist- Center for Orthopaedics
This position is: Full Time
Position Location: Center For Orthopaedics
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.
- Responsible for assuring
appropriate insurance verification, prior approvals, and all authorization
requirements are obtained prior to the patientís arrival for surgery or
- Communicate with physicians,
mid-level providers, and clinical staff as needed to obtain and understand
clinical documentation requirements.
- Provide required clinical
documentation to payers via phone, faxed forms, and/or website
- Responsible for relaying an
estimated cost of treatment.
- Ability to multi-task
prioritize and remain focused with a high-volume and time sensitive
- Contact referring providers both internal and external as needed.
- Clearly document authorization
approvals and denials in Practice Management systems including
authorization numbers and associated codes, dates, and other relevant
- Knowledge of CPT and ICD-10 terminology preferred.
- Basic knowledge of managed care
- Basic computer knowledge,
typing and 10-key skills needed.
- Previous knowledge of insurance
- Previous medical terminology
High school diploma or equivalent
- 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.
- Customer service experience; preferably in
healthcare related environment is preferred.
- Medical billing
experience and pre-cert experience is preferred.