Address
Form of work
SalaryPosition Overview:
As a Pre-certification Specialist, you will be responsible for communicating and maintaining information flow in the managed care referral process for contracted health plans.
Essential Duties & Responsibilities:
Oversee the managed care in-patient and outpatient referral and pre-authorization process
Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process
Maintain referral and authorization records documentation
Verify insurance for in-network eligibility and benefits
Field calls for prescription benefits questions and prescription verification
Contact referring physicians and secure authorizations for treatment
Communicate with hospitals to obtain pre-certification numbers
Maintain strict confidentiality required related to medical records and other data
Participate in professional development opportunities to stay current with health care practices and trends
Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office
Other duties as assigned
Required Skills:
High school diploma or equivalent, college courses, or certificate preferred
Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)
Ability to efficiently gather, organize, and comprehend insurance and/ or account information
Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill
Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology
Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo
Ability to learn quickly and contribute ideas that make the team, processes, and solutions better
Share our values: resilience, altruism, communication, achievement, and determination
Preferred Skills:
Two or more years of experience working in pre-certification or managed care
