Pre-Certification Specialist

Description

Summary

Obtain insurance pre-certification for procedures, surgery, injections, Visco-supplements, non-IBJI diagnostic imaging, and medication and other duties as assigned, to ensure efficient operations of practice.  

Responsibilities

• Provide day-to-day support to the practice by obtaining insurance authorizations as needed for procedures, surgeries, injections, Visco supplements, non-IBJI diagnostic imaging, and medications as assigned.
• Contacting patient’s health insurance carrier(s) to confirm eligibility
• Obtaining authorization for necessary service 
• Documenting insurance representatives name and phone number, authorization number, duration of treatment, length of stay (if applicable) and any other pertinent information in patient’s chart
• Providing either notice of authorization or notation that pre-certification is not required to the appropriate clinical staff
• Answer telephone calls in a timely manner, following-up or redirecting as needed.
• Document all patient account actions in the electronic health system including insurance phone calls, faxes, pre-certifications, follow-up activities, etc.
• Check faxes and messages and performs work necessary to respond to them.
• Communicate all staff issues/concerns to Clinical Manager.
• Communicate all physician issues to Clinical Manager.
• Complete other comparable duties and assignments as directed by the Clinical Manager.

Requirements

Experience

• Minimum of 1 year administrative/secretarial experience or equivalent required.
• Familiarity with rules and regulations of health insurance industry.
• Medical background a plus.

Qualifications   

• High school graduate or equivalent.
• Must be available to work a flexible schedule to meet the demands of a changing scheduling environment and accommodate the needs of the practice.
• Possess good working knowledge of Microsoft Office and Windows based computer applications. Able to interact with computers to set-up functions, enter data or process information.

 Skills     

• Must be a self-starter, highly organized with good time management skills.
• Able to multi-task and work in a fast-paced environment.
• Communicates effectively verbally and in writing to document/record information.
• Strong interpersonal skills, able to work well and communicate professionally with physicians, patients, insurance providers, and staff in all levels in the organization. Able to develop constructive and cooperative working relationships with others and maintain them over time.
• Capable of prioritizing and organizing information to achieve a smooth flow of tasks.
• Ability to interpret and explain an extensive variety of instructions. Ability to define problems, collect data, establish facts and draw valid conclusions.

Physical/Mental Demands

• Work may require hand dexterity for filing, office machine operation; using a calculator and/or computer keyboard.  
• Physical demands may also include stooping, bending or reaching to files and supplies, mobility to complete errands or deliveries, sitting for extended periods of time and viewing a computer monitor. 

Environmental/Working Conditions

• Work is performed in a clinic office environment and involves frequent contact with physicians and staff. 
• Work may be stressful at times.  
• Contact may involve dealing with angry or upset people.