Pre-Certification Specialist

Bone and Joint Center, S.C. • Wausau, WI

2d

About The Position

Bone & Joint is hiring a Pre-Certification Specialist to join its Pre-Certification/Verification of Benefits Team. The role involves completing a variety of tasks in a fast-paced environment and coordinating with departments across the organization, including providers, clinical teams, Ambulatory Surgery Center teams, registration, coding and billing, and therapy teams, as well as insurance carriers and outside hospital systems.

The specialist primarily obtains insurance prior authorizations online or by phone for provider-ordered procedures, surgeries, high-end imaging, durable medical equipment (DME), and other services. The role also includes verifying benefits for all patients to confirm active coverage and that their insurance plan is accepted at Bone & Joint clinics and walk-in locations. The position calls for strong customer service, attention to detail, patience, adaptability, and a positive approach to working with people at different levels.

Requirements

• High school diploma or equivalent.
• Patience and ability to work with people at all levels, internally and externally.
• Great attention to detail.
• At least 1 year of experience with online and telephone prior authorizations for services.
• Experience and knowledge of government, commercial, program, and private insurance.

Nice To Haves

• Medical insurance experience.
• Prior authorization experience.
• A positive attitude and ability to adapt quickly to change.

Responsibilities

• Obtain insurance prior authorizations online or by phone for provider-ordered procedures, surgeries, high-end imaging, durable medical equipment, and other services.
• Verify patient benefits to confirm active coverage and that the insurance plan is accepted at Bone & Joint clinics and walk-in locations.
• Communicate and coordinate with providers, clinical teams, Ambulatory Surgery Center teams, registration, coding and billing, therapy teams, insurance carriers, and outside hospital systems.
• Adapt to changing tasks and priorities in a fast-paced work environment.

What This Job Offers

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