Verification & Precertification Specialist

Join Our Team – Where People Make the Difference!

At Ellis & Badenhausen Orthopaedics, PSC, we believe that our success is driven by the right people—individuals with the right aptitude, positive attitude, and entrepreneurial spirit. We are committed to providing the Louisville community with the highest level of orthopaedic care. By maintaining a skilled, experienced team and staying at the forefront of medical technology and research, we ensure that patient care remains our primary focus.

About the Role:

As a Verification & Precertification Specialist, you will play a critical role in ensuring the financial integrity of each patient’s account to maximize reimbursement. You will be responsible for educating and communicating with patients and responsible parties regarding financial obligations or insurance-related issues. Your efforts will help streamline the process, ensuring a smooth and efficient experience for patients as they prepare for visits to our clinic or surgery facilities.

If you're passionate about making a difference in the lives of our patients and thrive in a collaborative, fast-paced environment, we would love to hear from you!

Overview:
We are seeking a highly skilled and detail-oriented Verification and Pre-certification Specialist to join our healthcare team. This role demands strong communication, organizational, and problem-solving abilities, with a solid understanding of healthcare insurance systems and industry regulations. You will work closely with patients, insurance providers, and internal teams to ensure smooth, timely, and compliant procedures.

Key Responsibilities:

Insurance Authorization & Verification:

• Contact insurance companies for pre-certification requirements.
• Initiate authorization requests and submit medical records such as chart notes, imaging reports, and op notes.
• Confirm patient eligibility and benefits via websites and phone.
• Code surgical procedures accurately for insurance processing.

Communication with Patients:

• Provide surgical cost estimates to patients and explain insurance benefits.
• Offer patient collection advice based on coverage and procedure details.
• Update patient information in the system, including insurance details and demographics.

Documentation & Record Keeping:

• Scan and upload pertinent medical records to patient charts.
• Maintain detailed notes on insurance verification and pre-certification statuses.
• Ensure timely documentation of insurance and patient communications.

Problem Identification & Resolution:

• Identify insurance-related issues that could delay surgery and communicate with relevant staff.
• Report and escalate compliance or regulatory issues to the Office Manager.

Customer Service & Compliance:

• Provide high-level customer service to patients, insurance companies, and internal teams.
• Ensure adherence to HIPAA and OSHA regulations.
• Stay informed on relevant laws and industry policies to maintain compliance.

Collaboration & Efficiency:

• Collaborate with coworkers, physicians, and external partners to enhance workflow.
• Constantly seek improvements in efficiency and risk reduction.

Analytical & Decision-Making Skills:

• Review and interpret data for accuracy and compliance.
• Make informed decisions based on available information and regulatory requirements.

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  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

• Ability to maintain strict confidentiality

• Willingness to support and encourage co-workers

• Accuracy

• Attention to detail

• Time Management

• Little supervision needed to accomplish tasks

• Skills in computer systems

• 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.

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  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.