Surgery Precertification Specialist

Wheaton Eye Clinic LTD•Wheaton, IL

4d•$21 - $24•Onsite

About The Position

Under supervision of the Physician Support Manager, the Surgical Precertification Specialist is responsible for obtaining preauthorization/precertification of all outpatient surgeries. The Surgical Precertification Specialist will possess outstanding communication and customer service skills and the ability to handle multiple tasks within a designated time frame. The Specialist will act as a liaison between our organization and insurance companies to promote the Wheaton Eye Clinic’s commitment to exceptional patient care.

Requirements

High school graduate or equivalent
Ability to read, write and speak in a clear and professional manner required
Knowledge of ICD-10 required

Nice To Haves

1 – 2 years insurance experience with knowledge of prior authorization processes preferred
1 – 2 years medical scheduling experience preferred
General knowledge regarding medical terminology preferred

Responsibilities

Contact insurance companies, HMO providers and/or local unions to initiate preauthorization for all outpatient surgeries.
Communicate with primary care physicians and utilization management organizations to obtain surgery authorizations for HMO patients; submit clinical information.
Follow up with requests in a timely manner to ensure a response is received with enough notice prior to surgery to prevent last-minute cancellations.
In the event of a denial, the Specialist will communicate the insurance’s decision with the surgeon, patient, facility and Surgery Scheduling staff accordingly.
Work with the Insurance Department staff to investigate all denials, and with assistance from providers, submit appeals as necessary.
Obtain authorizations for urgent add-on surgeries in a timely manner.
Respond to inquiries by telephone and / or written correspondence using quality customer service.
Respond to insurance companies’ or case managers’ requests for additional information.
Respond to requests from primary care physician’s offices for additional information.
Communicate with surgical facilities regarding preauthorization status.
Respond to calls from patients requesting preauthorization information.
Provide accurate, thorough and timely documentation of all information pertinent to patient treatment.
Assist with Surgery Scheduling tasks: Answer incoming calls to the department, Schedule and coordinate surgical appointments by phone, Coordinate any necessary preoperative testing, preoperative physical or clearance. Review patient’s health history for conditions that may affect surgery. Review preoperative and postoperative medications. Advise patients of instructions as guided by physicians’ protocols. Enter medication orders through electronic medical records to be prescribed by physicians for surgery. Contact primary care physicians and specialists’ offices to request history and physical reports or clearances for all surgery locations.