Pre-Certification Specialist

Alliance Spine and Pain Centers•Atlanta, GA

3d•Onsite

About The Position

Alliance Spine and Pain Centers is looking for a Full-Time Pre-Certification Specialist for our Buckhead location. This is a Monday-Friday position with a full benefits package. Job Summary Under general supervision verifies insurance, obtains referrals and pre-certs for surgeries and other procedures. Educates patients regarding the cost of treatment, insurance coverage and the patient’s responsibility for ensuring payment for all financial obligations to Alliance Spine & Pain Centers (ASPC).

Requirements

High school diploma or equivalent
PC proficiency
Data entry skill
Organization and attention to detail
Working knowledge of medical terminology
ICD-10 and CPT codes
Pre-certification and authorization experience in specialist office and radiology
Strong customer service skills.
Ability to maintain good relationships with insurance representatives.
Ability to effectively give and receive information from insurance carries, providers and ISPM employees.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Working knowledge of Eclinical.
Basic knowledge of Microsoft Office.

Nice To Haves

Insurance verification experience (strongly preferred)

Responsibilities

Identifies and obtains a referral authorization when appropriate.
Verifies appropriate network for claims processing.
Verifies and updates insurance benefits and referral information for existing patients and ensures current pre-certifications are obtained for procedures.
Obtains a new referral when necessary.
Updates patient accounts in practice management system.
Generate Letters of Medical Necessity as requested by Insurance Carriers.
Maintain an in depth awareness of billing policies and procedures.
Responds to staff or patient’s questions regarding insurance procedures and policies.
Serves as patient advocate during the cycle of the patient’s account as needed.
Notes information regarding patients’ benefits in the practice management system.
Attends insurance related meetings on and/or off-site.
Completes work within authorized time to assure compliance with departmental productivity.
Maintains clean and orderly workspace and organized files.
Clearly communicates thoughts verbally and in written form.
Maintains positive working relationship with patient concierges, Revenue Cycle managers and directors, and Regional Administrators.
Demonstrates knowledge of, and supports, ASPC/ IMS’ mission, vision, standards, policies and procedures, operating instructions, confidentiality standards, and the Code of Ethical Behavior.
Performs other assigned duties and special projects.
Ensures compliance with JCAHO.
Complies with all applicable HIPPA rules and regulations.