UR Pre-certification and Denials Specialist- Hybrid Schedule

OrthoCarolina•Charlotte, NC

1d•Hybrid

About The Position

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. OrthoCarolina is looking for a UR Pre-Certification Specialist- Hospital Pickup and Denials for our OrthoCarolina Business Office location in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs.

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.

Nice To Haves

Authorizations
Claims Processing
Health Insurance Verification
Insurance Authorizations
Insurance Eligibility Verification
Insurance Verification
Medical Billing and Coding
Medical Knowledge

Responsibilities

Receiving all OrthoCarolina claim denials for services not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections.
Investigating documentation for all departments.
Completely understanding the authorization process, medical criteria, denials, and appeals.
Serving as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized.
Verifying eligibility and benefits and obtaining any required authorization for all UR Departments.