Surgery Precertification Specialist

Wheaton Eye Clinic•Wheaton, IL

1d•Onsite

About The Position

The Surgical Precertification Specialist obtains preauthorization and precertification for outpatient surgeries and serves as a liaison between Wheaton Eye Clinic and insurance companies. Under the supervision of the Physician Support Manager, the specialist helps ensure authorizations are completed in time to avoid last-minute surgery cancellations and supports patients, providers, insurers, and surgical facilities with clear communication and accurate documentation. The role is performed in the office Monday through Friday, 8:00 a.m. to 5:00 p.m. The specialist also assists with surgery scheduling, including answering department calls, arranging surgical appointments, coordinating preoperative testing and clearances, reviewing patient health histories and medication instructions, entering medication orders in the electronic medical record for physician prescription, and requesting medical records and clearances from primary care and specialist offices.

Requirements

High school graduate or equivalent.
Ability to read, write, and speak clearly and professionally.
Knowledge of ICD-10.

Nice To Haves

One to two years of insurance experience with knowledge of prior authorization processes.
One to two years of medical scheduling experience.
General knowledge of medical terminology.

Responsibilities

Contact insurance companies, HMO providers, and local unions to initiate preauthorization for outpatient surgeries.
Coordinate with primary care physicians and utilization management organizations to obtain HMO surgery authorizations and submit clinical information.
Follow up on authorization requests promptly to obtain decisions with sufficient notice before surgery.
Communicate authorization denials to the surgeon, patient, facility, and Surgery Scheduling staff.
Work with Insurance Department staff to investigate denials and, with provider assistance, submit appeals when appropriate.
Obtain authorizations for urgent add-on surgeries in a timely manner.
Respond to inquiries by telephone and written correspondence with quality customer service.
Respond to insurance companies’ and case managers’ requests for additional information.
Respond to requests from primary care physicians’ offices for additional information.
Communicate preauthorization status to surgical facilities.
Respond to patient calls requesting preauthorization information.
Maintain accurate, thorough, and timely documentation of information pertinent to patient treatment.
Assist with Surgery Scheduling tasks, including answering incoming department calls and scheduling and coordinating surgical appointments by phone.
Coordinate required preoperative testing, physicals, and clearances, and review patient health histories for conditions that may affect surgery.
Review preoperative and postoperative medication instructions, advise patients according to physician protocols, and enter medication orders in the electronic medical record for physician prescription.
Contact primary care physicians’ and specialists’ offices to request history and physical reports or clearances for all surgery locations.