UR Pre-certification and Denials Specialist- Hybrid Schedule

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization.  OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit  https://www.orthocarolina.com/about-us 

OrthoCarolina is looking for a UR Pre-Certification Specialist- Hospital Pickup and Denials for our OrthoCarolina Business Office location in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs. 

The UR Pre-Certification Specialist- Hospital Pickup and Denials is responsible for receiving all OrthoCarolina claim denials for services not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections.  This role is required to be familiar with all areas of EMR (clinical, UR, transactions) and investigating documentation for all departments.  

Essential Functions: 

• Completely understanding the authorization process, medical criteria, denials, and appeals and will serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized.   

• Must have knowledge of claims processing as well as the ability to verify eligibility and benefits and obtain any required authorization for all UR Departments. 

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