Surgical Services Precertification Specialist

POSITION SUMMARY: With customer service orientation, verifies patient’s insurance benefits and eligibility.  Obtains required authorization, provides procedure codes and fee estimates and collects prepayment from patients when appropriate.

WHAT WE OFFER:

• Starting wage of $13 - 17 per hour based on previous experience


• 6.5 paid holidays per year


• Approximately 10 days of PTO within first year


• Full slate of benefits to include health, dental, vision, and 401k


• Growth and wage increase through company paid certification program

ESSENTIAL RESPONSIBILITIES:

• Monitor scheduled surgeries and maintain organized list with status of pre-certification process.


• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in Eyecare as required.


• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.


• Verify receipt of all necessary pre-authorization documents prior to procedure.


• Communicate effectively with the facility in which the procedure will be performed as needed.


• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.


• Notify primary care physician for managed care plans that require PCP authorization.


• Supply patients with written or verbal estimates of surgical codes and fees upon request. 


• Meet with patients pre-operatively or communicate effectively as necessary with patients so they understand the billing process and their financial expectations pre-operatively.


• Collect pre-payment from the patient when necessary. 


• Notify patients with past due accounts of pre-payment policy for elective surgery.  Receive payments from patients. 


• Assist with check-in and check-out when needed.  Serve as a resource on insurance, billing and customer service for reception and cashier.


• Monitor cash box and report balance to supervisor and accounting department monthly.


• Perform other duties or functions as assigned.

EDUCATION AND/OR EXPERIENCE:  

• A minimum of two (2) year's experience in the medical field.


• Must have a strong knowledge of anatomy, physiology, medical terminology, and medical insurance.

 PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA guidelines):

• Physical Activity: Talking, Hearing, Repetitive motion.


• Physical Requirements: Sedentary work. Involves sitting most of the time.


• The worker is required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.