Epidural Pre-Certification Representative

Rothman Orthopaedics•Philadelphia, PA

3d•Remote

About The Position

The Pre-Certification Representative ensures accurate, efficient processing and interaction with all insurance companies and staff with regard to pre-certification. This role is responsible for processing all incoming requests for pre-certification and authorization for upcoming procedures, reviewing requests for appropriate information, and ensuring patients have adequate coverage. The representative will also manage workers’ compensation and auto pre-certifications and communicate denials and initiate appeals.

Requirements

High School diploma or GED minimum education requirement
Medical office operations and medical terminology knowledge required
Computer skills including, but not limited to, MS Office Suite

Nice To Haves

One year of pre-certification experience highly preferred

Responsibilities

Processes all incoming requests for pre-certification and authorization for upcoming procedures being performed by a physician or department at Rothman Institute.
Reviews all requests for appropriate information required to get approval and accurate benefit information.
Reviews physician schedules prior to scheduled procedures to ensure all have been pre-certified or authorized.
Reviews benefits to ensure patient has adequate coverage and communicates high out-of-pocket expenses to the Financial Counseling team.
Notates patient's account with all information relevant to the authorization and pre-certification process, including filling out Structured Data fields in eCW referral.
Faxes/uploads required pre-certification paperwork to insurance company, adjuster or medical review department to ensure authorization is obtained.
Responsible for pre-certification process in its entirety, including communicating denials and initiating appeals.
Manages all workers’ compensation and auto pre-certifications due to additional time required by these payers to obtain approval.
Daily report of completed vs pending pre-certs, monthly total of pre-certs by FTE, number of cancellations by physician/FTE.