UR Pre-certification and Denials Specialist- Hybrid Schedule
About The Position
OrthoCarolina is seeking a UR Pre-Certification Specialist- Hospital Pickup and Denials for their OrthoCarolina Business Office location in Charlotte. This position offers a hybrid schedule with rotating days in the office based on department needs. The specialist will be responsible for managing all OrthoCarolina claim denials for services that were not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections. This role requires familiarity with all areas of the EMR (clinical, UR, transactions) and the ability to investigate documentation from all departments.
Requirements
- Familiarity with all areas of EMR (clinical, UR, transactions).
- Knowledge of claims processing.
- Ability to verify eligibility and benefits.
- Ability to obtain any required authorization for all UR Departments.
- Understanding of the authorization process, medical criteria, denials, and appeals.
Responsibilities
- Receive all OrthoCarolina claim denials for services not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections.
- Investigate documentation for all departments.
- Serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized.
- Verify eligibility and benefits.
- Obtain any required authorization for all UR Departments.
Benefits
- Paid company holidays
- Wellness programs
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
