Precertification Specialist
About The Position
Responsible for the verification of insurance benefits and obtaining prior authorizations for all scheduled procedures as needed by successfully performing duties within the policy and procedures outlined. Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.
Requirements
- High school diploma or GED
- 2 years of medical field experience
- Understanding of payer medical policies and guidelines pertaining to prior authorization requirements
- Detail oriented
- Excellent customer service skills; communicating clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
- Computer skills including Excel, Word and internet use
- Active & Current Driver’s license
- Clean driving record
- Consistent and Reliable Transportation
- Polite and professional disposition
Nice To Haves
- At least 1 year of pre-certification experience preferred
- Epic experience preferred but not required
Responsibilities
- Obtain and confirm insurance benefits via online or telephone
- Obtain prior approvals as required by payer plan with regular follow-up as needed
- Communicate detailed policy benefits and expected pre-payments to patients
- Communicate with provider offices as needed
- Entering patient credit card prepayments into Epic
- Prioritize work queue into date of service order and or specific payer and or procedural needs
- Ability to meet the physical and mental demands of the position
- The ability to work on-site
- Predictable, reliable, and prompt attendance
- Obtaining prior authorizations for all scheduled surgical, DME, allergy, V&S, and radiology orders by successfully completing the approved authorization process for all payers.
- Monitoring assigned work queues
- Contacting payers
- Contacting patients about any pre-service payments
- Address emails/in-baskets
- Address voicemails
- Scanned faxes
- Communicating as needed with provider offices
- Work independently and solve routine type issues
- Report potential systemic issues to the Precertification Team Supervisor
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
