What are the responsibilities and job description for the Surgical Services Precertification Specialist position at Davis Eye Center?
POSITION SUMMARY: With customer service orientation, verifies patient’s insurance benefits and eligibility. Obtains required authorization, provides procedure codes and fee estimates and collects prepayment from patients when appropriate.
WHAT WE OFFER:
- 6.5 paid holidays per year
- Approximately 10 days of PTO within first year
- Employee Referral Program
- Full slate of benefits to include health, dental, vision, and 401k
- Growth and wage increase through company paid certification program
ESSENTIAL RESPONSIBILITIES:
- Monitor scheduled surgeries and maintain organized list with status of pre-certification process.
- Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in Eyecare as required.
- Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
- Verify receipt of all necessary pre-authorization documents prior to procedure.
- Communicate effectively with the facility in which the procedure will be performed as needed.
- Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
- Notify primary care physician for managed care plans that require PCP authorization.
- Supply patients with written or verbal estimates of surgical codes and fees upon request.
- Meet with patients pre-operatively or communicate effectively as necessary with patients so they understand the billing process and their financial expectations pre-operatively.
- Collect pre-payment from the patient when necessary.
- Notify patients with past due accounts of pre-payment policy for elective surgery. Receive payments from patients.
- Assist with check-in and check-out when needed. Serve as a resource on insurance, billing and customer service for reception and cashier.
- Monitor cash box and report balance to supervisor and accounting department monthly.
- Perform other duties or functions as assigned.
EDUCATION AND/OR EXPERIENCE:
- A minimum of two (2) year's experience in the medical field.
- Must have a strong knowledge of anatomy, physiology, medical terminology, and medical insurance.
PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA guidelines):
- Physical Activity: Talking, Hearing, Repetitive motion.
- Physical Requirements: Sedentary work. Involves sitting most of the time.
- The worker is required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.