Pre-Certification Collection Specialist- Charlotte, NC

OrthoCarolina•Charlotte, NC

7d•Hybrid

About The Position

OrthoCarolina is seeking a Pre-Certification Collection Specialist to join its Utilization Review team in the Business Office in Charlotte, North Carolina. This hybrid position has rotating in-office days depending on department needs. The specialist serves as a liaison between patients, insurance companies, physicians, and facilities, and handles a large volume of calls to patients and insurers. The role includes verifying eligibility, benefits, and precertification; collecting patients’ financial responsibility; tracking accounts associated with scheduled appointments; resolving internal account issues to expedite insurance payments; and using online tools to review benefits and medical criteria, check prior plan approval requirements, and initiate and obtain authorizations.

Requirements

High school diploma or GED required.
At least one year of experience in insurance verification and authorizations.
Knowledge of physician, facility, and hospital precertification.

Nice To Haves

Associate or bachelor's degree preferred.

Responsibilities

Confirm eligibility, benefits, and precertification with insurance carriers for patients scheduled with a physician and facility.
Pre-collect patient balances, including unpaid current balances and estimated financial responsibility up to and including the full out-of-pocket amount when necessary.
Track accounts from notification of scheduled appointments, including same-day and next-day add-ons, for authorization and pre-collection of patient financial responsibility.
Identify and correct internal problems within assigned accounts to expedite payments from insurance companies.
Use online tools to review benefits, medical criteria and policies, and prior plan approval requirements, and to initiate and obtain authorizations.
Serve as a liaison among patients, insurance companies, physicians, and facilities, including handling a large volume of calls.