Pre Authorization / Pre-certification Specialist

Come join a team where People make the difference! We rely heavily on people with the right aptitude, attitude and entrepreneurial spirit to drive our success. Ellis & Badenhausen Orthopaedics, PSC is dedicated to providing the Louisville community with the highest quality of orthopedic service. We will ensure that patient care remains the focus of our medical practice by maintaining an experienced staff and by keeping on the forefront of medical technology and research.

About the role;

To ensure the financial integrity of each patient’s account generated to maximize reimbursement. Educate and communicate to patients and/or responsible parties of any financial responsibilities, or insurance issues in order to streamline the process.

Position Title: Pre Authorization / Pre-certification Specialist

Reports to: Office Manager

This Position Features

Generous pay and benefits including a 401k and profit-sharing plan!

Pre-certification Job Duties

Complete all authorization/pre-certification to improve patient satisfaction
Contacts insurance company for authorization/precertification requirement, initiate request and deliver pertinent medical records, i.e., chart notes, diagnostic imaging reports, and op notes, to expedite process; obtains patient eligibility and benefits via phone (live/automated) or online portal.
Completes and provides estimates to patients
Confirms all eligible appointments and scans all pertinent documentation to patient’s chart.
Notates pertinent information in the system regarding patient insurance verification/pre-certification status and patient financial responsibility.
Notifies appropriate staff and clinical team of any problematic insurance issue that may lead to surgery delay.
Compiles pertinent medical records information, i.e., chart notes, diagnostic imaging reports, op notes, etc.
Reviews and documents insurance and patient correspondence in the system in a timely manner.
Provides patient collection advice & benefit interpretations
Updates patient information in computer, i.e., insurance information, demographics, etc. when notified of changes by the patient
Provides support to verifications, procedure authorizations and patient balance inquiries
Displays the highest level of customer service, attentiveness and consideration possible in all surgery cases.
Stays abreast of laws and regulations that might affect the organization’s policies and procedures
Constantly monitors for ways to increase efficiency and reduce risk within the organization
Communicates potential risk to the Billing Director
Report and follow directives of HIPAA and OSHA compliance officers
Any additional duties as assigned
Cooperative work attitude toward co-employees, management, patients, visitors, outsourced companies and physicians
Ability to promote favorable facility image with physicians and general public
Ability to make decisions and solve problems.
Ability to analyze and interpret data.
Ability to research and prepare comprehensive reports/summaries.
Ability to communicate clearly and effectively in writing and verbally.

Qualifications;

At least one year of professional experience in medical billing office preferred
Strong in Excel and MS Word skills
Strong analytical and problem-solving skills with the ability to define root causes of concern as they arise.
Strong ethical and moral character references
Good communication skills
Good computer skills
Ability to maintain strict confidentiality
Willingness to support and encourage co-workers
Accuracy
Attention to detail
Timeliness
Time Organization
Little supervision needed to accomplish tasks
Skills in computer systems
Knowledge of operating systems, word processing, spreadsheets, and 10-key touch
Skill in organizing tasks.
Attendance
Punctuality
Ability to follow instructions
Ability to meet deadlines
Ability to sit for long periods of time, stand, and walk
Visual and auditory acuity for frequent use of computer, telephone, and use of other office equipment
Manual dexterity using calculator and computer keyboard
Standing, sitting 10 hours/day while doing computer input and responding to phone questions. Occasional stress in working with employees and multiple tasks.
Well lit and ventilated, with non-hazardous and hazardous equipment
Busy office environment

We are an equal opportunity employer

Ellis & Badenhausen Orthopaedics, PSC is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, creed, gender, marital status, sexual orientation, color, religion, national origin, age, disability, veteran status, or any other status protected under local, state, or federal laws. Applicants must be eligible to work in the USA.

Ellis & Badenhausen Orthopaedics

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Pre - Authorization Specialist