PRE CERTIFICATION SPECIALIST - REMOTE

PRE-CERTIFICATION SPECIALIST   Obtain authorizations for Imaging procedures, Surgical procedures, DME, Botox, Visco, and Pain management, as well as obtaining PT benefits from various insurance providers via phone call or web portal.  Professionally represent all OrthoAlliance practices to the upmost standard quality with patient interest in mind. By becoming a pre-certification specialist, you will work directly with physician staff to ensure all patient needs are handled in a timely manner.   Full-Time Remote Position Monday thru Friday     Position Responsibilities/Standards:  

• Attending department, clinic or company meetings as
• Demonstrate sound judgment by taking appropriate actions regarding questionable findings or
• Consistently work in a positive and cooperative manner with fellow staff
• Consistently demonstrate ability to respond to changing situations in a flexible manner to meet current needs, such as reprioritizing work as
• Attend required annual in-service
• Demonstrate knowledge and understanding of all company policies and
• Adheres to established facility safety requirements and procedures to ensure a safe working environment. Identifies potentially unsafe situations and notifies

  Specific Responsibilities:  

• Check scheduling system for new patients that will require insurance pre-
• Verify insurance eligibility and benefits via phone and/or internet
• Prioritize incoming authorization requests according to urgency.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Follow up on all pending
• Update insurance policy information in NextGen system as
• Serve as a resource on insurance authorization and estimated cost
• Handle personal and confidential correspondences, email, and
• Maintain patient files, keeping abreast of insurance changes of recertification
• Work with the billing company representatives as well as clinic staff to complete tasks in a timely
• Discuss out of network concerns or lack of insurance coverage with the physician(s)
• Answer phone calls from insurance companies.

  Education/Experience Required:  

• Must be a high school graduate or previous experience
• Must have strong communications
• Must have computer and word processing abilities
• Previous medical office experience is 
• Precertification knowledge preferred

 

Physical Requirements:   Physical requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Must be able to climb, pull, push, and kneel. Maximum unassisted lift= 25 lbs. Average lift to IO lbs.