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OrthoAlliance · 1 day ago

PRE CERTIFICATION SPECIALIST-REMOTE

United States

Contract

Remote

New Grad, Entry Level

OrthoAlliance is a healthcare organization seeking a Pre Certification Specialist. The role involves obtaining authorizations for imaging and surgical procedures from insurance providers while ensuring patient needs are met efficiently and professionally.

Health CareMedicalPersonal Health

Responsibilities

Attend department, clinic or company meetings as required

Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns

Consistently work in a positive and cooperative manner with fellow staff members

Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary

Attend required annual in-service programs

Demonstrate knowledge and understanding of all company policies and procedures

Adheres to established facility safety requirements and procedures to ensure a safe working environment. Identifies potentially unsafe situations and notifies supervisor

Check scheduling system for new patients that will require insurance pre-certification

Verify insurance eligibility and benefits via phone and/or internet access

Prioritize incoming authorization requests according to urgency

Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order

Follow up on all pending authorizations

Update insurance policy information in NextGen system as required

Serve as a resource on insurance authorization and estimated cost questions

Handle personal and confidential correspondences, mail and reports

Maintain patient files, keeping abreast of insurance changes of recertification needs

Work with the billing company representatives as well as clinic staff to complete tasks in a timely manner

Communicate with patients to schedule appointments and procedures. Work with patients whose procedures are not approved

Discuss out of network concerns or lack of insurance coverage with the physician(s) prior to notifying the patient of his or her coverage

Assist with the completion and update of Worker Compensation forms. Verify authorization from Workers Compensation to verify coverage for appointments

Answer phones