Pre-Certification Specialist

Description

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

• Verifies insurance coverage to ascertain deductible and coinsurance amounts, obtaining precertification/authorization.
• Notifies patients of expected financial responsibility that will be due at the time of service.
• Schedules pre-authorized services and follow-up office visits as needed.
• Provides explicit instructions to patients regarding time of arrival, place of service, and documentation necessary for office visits.
• Enters benefits and precertification/authorization into EMR system (Referral Management).
• Coordinates with referring physician offices when necessary to pre-authorize services.
• Coordinates with AOA business office to evaluate and resolve reimbursement issues.
• Maintains work area in a neat and orderly manner at all times.
• Attends scheduled staff meetings.
• Availability to work in the office setting Monday-Friday.
• Additional responsibilities as assigned by Director of CBO.

Requirements

 EDUCATIONAL REQUIREMENTS:

• High School Diploma/GED or equivalent experience.

QUALIFICATIONS AND EXPERIENCE

• Computer literate, with keyboard skills-working knowledge of practice management software.
• One or more years’ experience in insurance verification / precertification in a medical office or hospital setting preferred.
• Knowledge of medical terminology.
• One year or more of work experience in various areas of medical insurance preferred.
• Knowledge of CPT and ICD-9 coding.
• Pleasant speaking voice and demeanor.
• Neat, professional appearance.
• Ability to perform in a highly stressful situation.
• Ability to multitask.
• Ability to focus and maintain direction in the tasks at hand under pressure.
• Ability to establish effective working relationships with patients, physicians, insurance representatives and other medical support staff.
• Background in medical terminology and orthopedics preferred.
• Ability to analyze various medical situations for scheduling purposes