Precertification Rep - DOC

HH Health System•Decatur, AL

About The Position

The Orthopaedic Center is seeking a highly motivated AR Precertification Specialist for its affiliate, DOC Orthopaedic and Sports Medicine. This full-time position averages 40 hours per week. The specialist pre-certifies patients for office visits, consultations, testing, and procedures as required by their insurance companies by monitoring patient schedules in the billing system for each department. The role also assists accounts receivable, coding, registration, and insurance follow-up staff as needed, responds to departmental questions about insurer pre-certification requirements, and maintains confidentiality.

Requirements

High school diploma or GED.
Knowledge of coding, accounts receivable, and insurance reimbursement.
Ability to work under pressure.
Outstanding organizational and writing skills.
Ability to speak clearly and concisely.
Independent, self-starting, and highly motivated.
A proven positive teamwork attitude in work history.

Nice To Haves

Three years of insurance and/or billing experience preferred.
One year of healthcare experience preferred.

Responsibilities

Pre-certify patients for office visits, consultations, testing, and procedures according to insurance company requirements.
Monitor patient schedules in the billing system for each department.
Obtain pre-certification approvals using required methods, such as calling, faxing, emailing, or accessing insurer systems online.
Assist accounts receivable, coding, registration, and insurance follow-up staff as needed.
Respond to requests from various departments regarding insurance company pre-certification requirements.
Review insurance company pre-certification requirements in a timely manner and maintain up-to-date knowledge of them.
Notify appropriate staff about approval or denial status.
Forward denials to the manager and appropriate staff for further review and decision-making.
Maintain strict confidentiality.
Perform other duties as assigned.