PRE CERTIFICATION SPECIALIST-REMOTE

Job Description

Job DescriptionPRE-CERTIFICATION SPECIALISTObtain authorizations for imaging procedures, Surgical procedures, DME, Botox, Visco and Pain management as well as obtaining PT benefits 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 remoteComplete Job Description Below______________________________________________________________________________________________________________________________________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.
• Discuss out of network concerns or lack of insurance coverage with the physician(s) prior to notifying the patient of his or her coverage..
• Answer phones.

Education/Experience Required:

• Must be a high school graduate or equivalent.
• Must have excellent public relations skills.
• Must have computer and word processing ability.
• Previous medical office experience is preferred.
• Precertification knowledge 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.