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SalaryPRE-CERTIFICATION SPECIALIST
Obtain authorizations for imaging procedures, surgical procedures and injections from various insurance providers via phone call or web portal. Professionally represent Beacon Orthopaedics/OrthoAlliance to the upmost standard quality with patient interest in mind. By becoming a pre-certification specialist, you will work directly with physician staff to ensure all patient needs are handled in a timely manner.
Full-Time Employment / Position is remote
Complete Job Description Below
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Position Summary:
Perform insurance pre-certification to all new patients.
Position Responsibilities/Standards:
General
- Attend department, clinic or company meetings as required
- Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns
- Consistently work in a positive and cooperative manner with fellow staff members.
- Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
- Attend required annual in-service programs.
- Demonstrate knowledge and understanding of all company policies and procedures.
- Adheres to established facility safety requirements and procedures to ensure a safe working environment. Identifies potentially unsafe situations and notifies supervisor
Specific Duties
- Check scheduling system for new patients that will require insurance pre-certification.
- Verify insurance eligibility and benefits via phone and/or internet access.
- Prioritize incoming authorization requests according to urgency.
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Follow up on all pending authorizations.
- Update insurance policy information in NextGen system as required.
- Serve as a resource on insurance authorization and estimated cost questions.
- Handle personal and confidential correspondences, mail and reports.
- Maintain patient files, keeping abreast of insurance changes of recertification needs.
- Work with the billing company representatives as well as clinic staff to complete tasks in a timely manner.
- Communicate with patients to schedule appointments and procedures. Work with patients whose procedures are not approved.
- Discuss out of network concerns or lack of insurance coverage with the physician(s) prior to notifying the patient of his or her coverage.
- Assist with the completion and update of Worker Compensation forms. Verify authorization from Workers Compensation to verify coverage for appointments.
- Answer phones.
Education/Experience Required:
- Must be a high school graduate or equivalent.
- Must have excellent public relations skills.
- Must have personal computer and word processing ability.
- Previous medical office experience is preferred.
Physical Requirements:
Physical requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Must be able to climb, pull, push and kneel. Maximum unassisted lift = 25 lbs. Average lift up to 10 lbs.
Experience
Preferred- Previous medical office experience is preferred.
Education
Preferred- High School or better
