Precert Specialist - Pain Mgt

Carolina Orthopaedic and Neurosurgical Associates • Spartanburg, SC

2d • Onsite

About The Position

Medical Office Personnel with administrative responsibilities focus on obtaining pre-certifications and authorizations for procedures for our pain management physicians. The candidate must be detail-oriented, focused, organized, and a team player with an attitude to contribute meaningfully to the practice.

Requirements

• Working knowledge of medical terminology, insurance packages/plans, and proficient with EMR
• Clearly communicate with providers, insurance companies, and staff.
• Excellent verbal and written communication skills
• Excellent organizational skills, multi-tasking capabilities, and detail-oriented
• Customer Services skills
• Basic Computer/PC and Internet skills
• Attention to detail and problem-solving skills
• Must be a great team player
• 1 to 2 years Work Experience
• High School Education Level

Nice To Haves

• 1 year precertification experience

Responsibilities

• Contact insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services.
• Call insurance companies or use online tools to obtain preauthorization.
• Follows up timely and thoroughly.
• Ensures all preauthorization issues are communicated in a timely manner.
• Liaisons with the physician’s staff to obtain additional insurance and/or clinical information.
• Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service.
• Follows up properly on all denials and peer-to-peer requests.
• Documents appropriately regarding all actions, authorization, and denials.
• Able to prioritize, work accurately, work well independently, and able to maintain focus under pressure.

What This Job Offers

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