Insurance Authorization Specialist

Nebraska Spine Center LLP • Omaha, NE

1d • Onsite

About The Position

Nebraska Spine and Pain Center is seeking a Pre-Certification Specialist for their Business Office. This full-time, non-exempt/hourly role is crucial in ensuring patients receive the care they need without unnecessary delays. The specialist will be responsible for obtaining and tracking insurance authorizations for outpatient and surgical procedures, working directly with payers and ensuring compliance with HIPAA and current payer and coding standards. This position offers the opportunity to make a positive impact on patients' lives by streamlining their access to medical care.

Requirements

• Prolonged periods of sitting at a desk and working on a computer
• Prolonged periods of phone-based communication
• Ability to lift up to 10 pounds occasionally
• Ability to manage multiple competing tasks and deadlines
• High attention to detail and accuracy
• Excellent verbal and written communication skills required
• Excellent telephone etiquette
• Detail oriented
• High school diploma or equivalent

Nice To Haves

• Knowledge of insurance terms, medical terminology, CPT and ICD-10 codes preferred
• Prior experience in medical insurance authorization, medical billing, or a related healthcare business-office function preferred

Responsibilities

• Performs pre-certification of outpatient procedures, including MRI, CT, injection, and in-house procedures, based on the ordering provider’s clinical order and current payer medical-policy criteria.
• Performs pre-certification of surgical procedures, submitting clinical documentation provided by the ordering physician or advanced practice provider.
• Follows up on pending pre-certifications with insurance carriers within established turnaround-time standards.
• Maintains working knowledge of CPT and ICD-10-CM coding conventions sufficient to support accurate, compliant pre-certification submissions; escalates coding questions requiring clinical judgment to the appropriate clinical or coding staff.
• Answers patient phone calls and provides status updates on pre-certification requests, disclosing only the minimum necessary protected health information consistent with HIPAA privacy standards.
• Documents all payer communications, determinations, and pre-certification status accurately and timely in the practice management system/EHR.
• Assist business office staff with outpatient scheduling for imaging, injections and surgical.
• Provide float or cross-coverage support to other departments as needed.
• Other duties may be assigned at times as determined by a supervisor to meet the needs of the organization.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED