Pre-Authorization specialist

Description

Job Summary:

Perform insurance pre-certification duties for surgical procedures, MRI scans, and injections. Make payment arrangements for estimated patient responsibility for surgical procedures, MRI scans, and injections per policy; provide excellent patient services via telephone and in person.

Essential Duties & Responsibilities:

Correct Insurance Company

• Obtain correct insurance company information such as Workers' Compensation vs. commercial insurance, including telephone number and policy numbers from system.

Pre-Certification/Pre-Authorization

• Contact insurance companies to obtain pre-certification for all outpatient surgical procedures, inpatient surgical procedures, short-stays, MRI and CT scans, and injections, if required by the insurance plan.

Insurance Benefits

• Obtain insurance benefit information and calculate pre-surgical payments for all surgical procedures performed at all locations and for all MRIs perfomed at Premier Bone and Joint Centers' locations.

Contact Patient

• Contact patients regarding estimated patient responsibility amounts for all surgical procedures, MRIs, and injections scheduled at all Premier Bone & Joint Centers' locations, review all outstanding balances with patients, and design payment arrangements if necessary.

Surgical Charts

• Assemble ASC surgical charts and deliver the charts to the front desk the day before the scheduled surgical procedure.

Pre-Payment Information

• Provide pre-payment information to the front desk staff.

Insurance Carrier Tools

• Use insurance carrier tools to estimate patient out-of-pocket costs.

Insurance Contractual Discounts

• Knowledge of insurance contractual discounts.

Insurance Provider Policy Knowledge

• Knowledge of insurance provider policies and procedures regarding patient claims.

Medical Terminology Knowledge

• Knowledge of medical terminology and basic human anatomy.

Interpersonal Skills:

Working Relationships

• Ability to establish and maintain effective working relationships with physicians, co-workers and the public that harbor a friendly, yet professional interaction. Demonstrate willingness to readily interact with other staff members and department.

Mentor

• Acts as a mentor for new employees.

Personal Growth

• Accepts responsibility for own professional growth and personal conduct by seeking knowledge in work specific areas, taking advantage of opportunities at work to observe and volunteer.

Flexibility and Stressful Situations

• Ablility to be flexible, organized, and function under stressful situations.

Adherence to Facility/Departmental Policy:

Confidentiality

• Observe confidentiality of information in regards to patients, physicians, and fellow employees; ability to maintain confidentiality under HIPAA standards.

Attendance/Punctuality

• Maintains a good attendance record and arrives to work punctually.

Overtime

• Able to substantiate overtime, minimizes overtime and adjusts hours as needed.

Dress Code/Identification

• Follow dress code of the department, appear professional when present in the clinic, wear identification while on duty, and communicate name and role to patient appropriately.

Cell Phone Use

• Cell phone may be used for business purposes only. Utilizes cell phone for personal use only during breaks or meal periods out of the public eye.

Staff Meetings/In-services

• Participates in Premier Bone & Joint Centers and departmental in-services and staff meetings.

Safety & Infection Control Policies

• Adhere to safety and infection control policies.

Care of Environment, Equipment, and Supplies:

Clean, Neat, Safe Environment

• Maintain a clean, neat, and safe environment for patients and staff, including personal work areas.

Office Equipment Skills/Malfunctioning Equipment

• Utilizing correct/safe technique when using equipment and notify manager of malfunctioning equipment.

Requirements

Education:

• High School Diploma or Equivalent General Required

Experience:

1 Year - Business Office Type Experience - Preferred

Physical Requirements:

Seeing - Must be able to read reports and use a computer - Constant

Hearing - Must be able to hear well enough to communicate with patients, physicians, administrative staff, insurance