UR Pre-Certification Specialist- Hospital Pickup and Denials (Hybrid Schedule)

OrthoCarolina • Charlotte, NC

96d

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. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. 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. The UR Pre-Certification Specialist- Hospital Pickup and Denials is responsible for receiving all OrthoCarolina claim denials for services not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections. This role is required to be familiar with all areas of EMR (clinical, UR, transactions) and investigating documentation for all departments.

Requirements

• Associates degree preferred, but not required.
• Two years of experience in medical pre-certification and pre-collection.
• Experience in utilizing insurance website for verifying eligibility, benefits and obtaining pre-certification.

Nice To Haves

• Knowledge of Authorizations.
• Experience in Claims Processing.
• Skills in Health Insurance Verification.
• Experience with Insurance Authorizations.
• Experience with Insurance Eligibility Verification.
• Experience in Medical Billing and Coding.
• Medical Knowledge.

Responsibilities

• Completely understanding the authorization process, medical criteria, denials, and appeals.
• Serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized.
• Have knowledge of claims processing as well as the ability to verify eligibility and benefits.
• Obtain any required authorization for all UR Departments.

Benefits

• Paid company holidays.
• Wellness programs.
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree