Pre-Authorization Specialist

ONET Systems, LLC is a leading Revenue Cycle Management organization dedicated to providing exceptional service to our clients. We are committed to delivering high-quality services and innovative solutions to our provider and facility practices. As we continue to expand our operations, we are seeking a talented and experienced Pre-Authorization Specialist to join our team in the New York area.

We are currently seeking a highly skilled Pre-Authorization Specialist with a minimum of 1 year of recent experience in handling pre-authorizations for a variety of surgical practices, particularly in orthopedics, pain management, and ambulatory surgical centers. The ideal candidate will have a strong understanding of insurance verification processes, pre-authorization requirements, and medical terminology. The successful candidate will play a critical role in facilitating timely pre-authorizations for patient procedures, ensuring seamless coordination between healthcare providers, insurance companies, and patients.

Responsibilities:

• Conduct thorough insurance verification and eligibility checks for patients scheduled for procedures at out-of-network surgical practices.
• Collaborate with healthcare providers to gather necessary documentation and medical records for pre-authorization submissions.
• Communicate effectively with insurance companies to obtain pre-authorization for orthopedic, pain management, and ambulatory surgical procedures.
• Maintain accurate records of pre-authorization requests, eligibility requests, pre-determination requests, approvals, denials, and follow-up actions.
• Provide support to patients and healthcare providers regarding pre-authorization status, coverage details, and potential financial responsibilities.
• Stay updated on changes in insurance policies, pre-authorization guidelines, and reimbursement processes.

Qualifications:

• Minimum of 1 year of recent experience working in pre-authorizations for out-of-network surgical practices, with a focus on orthopedics, pain management, and ambulatory surgical centers.
• Strong knowledge of medical terminology, insurance verification processes, pre-determinations and pre-authorization requirements.
• Excellent communication skills, both verbal and written, with the ability to effectively interact with healthcare providers, insurance companies, and patients.
• Detail-oriented with strong organizational and time management skills.
• Ability to work independently and prioritize tasks in a fast-paced environment.
• Proficiency in using electronic health records (EHR) systems and insurance verification software.
• Certification in medical billing and coding is preferred but not required.
• Proficiency in using Excel is preferred but not required.
• Experience using Office 365 is preferred.