Precertification Specialist

TOC- The Orthopaedic Center • Decatur, AL

9h • Onsite

About The Position

This role involves pre-certifying patients for various medical services, ensuring compliance with insurance company requirements. The specialist will monitor patient schedules, communicate with insurance providers through various channels, and collaborate with internal departments. Maintaining up-to-date knowledge of insurance requirements and handling approvals/denials are key aspects of the position. Confidentiality and efficient workflow are essential.

Requirements

• HS/GED required
• Ability to communicate effectively with patients, DOC physicians and staff
• Ability to work under pressure and deadlines
• Outstanding organizational, verbal and writing skills
• Independent, highly motivated
• Exhibit initiative and self-discipline
• Proven positive, “teamwork” attitude and work history

Nice To Haves

• Previous insurance precert experience preferred
• Previous surgery or procedure scheduling preferred

Responsibilities

• Pre-certify all patients for office visits, consultations, testing, and procedures as required by each patient’s insurance company by monitoring patient schedules in the billing system for each department
• Follow insurance company pre-certification requirements for approval, such as calling, faxing, emailing, logging into their system online, etc.
• Assist accounts receivable, coding, registration, and insurance follow up staff on an as-needed basis
• Answer requests from various departments regarding pre-cert requirements for various insurance companies
• Reviews pre-cert requirements for insurance companies in a timely manner to maintain up-to-date knowledge of requirements
• Notifies appropriate staff on status of approval/denials.
• Forwards denials to manager and appropriate staff for further review and decision making
• Maintains strict confidentiality
• Performs related work as required

What This Job Offers

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