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.
