What are the responsibilities and job description for the Pre-Certification Specialist position at Resurgens Orthopaedics?
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Job Type
Full-time
Description
RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
EDUCATIONAL REQUIREMENTS
Job Type
Full-time
Description
RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:
- Verifies insurance coverage to ascertain deductible and coinsurance amounts, obtaining precertification/authorization for durable medical equipment and other services as needed.
- Notifies patients of expected financial responsibility that will be due at the time of service.
- Schedules pre-authorized services and follow-up office visits as needed.
- Provides explicit instructions to patients regarding time of arrival, place of service, and documentation necessary for office visits.
- Enters benefits and precertification/authorization into EMR system (Referral Management).
- Coordinates with referring physician offices when necessary to pre-authorize services.
- Coordinates with AOA business office to evaluate and resolve reimbursement issues.
- Maintains work area in a neat and orderly manner at all times.
- Attends scheduled staff meetings.
- Availability to work in the office setting Monday-Friday.
- Additional responsibilities as assigned by Director of CBO.
EDUCATIONAL REQUIREMENTS
- High School Diploma/GED or equivalent experience.
- Computer literate, with keyboard skills-working knowledge of practice management software.
- One or more years of DME experience.
- One or more years' experience in insurance verification / precertification in a medical office or hospital setting preferred.
- Knowledge of medical terminology.
- One year or more of work experience in various areas of medical insurance preferred.
- Knowledge of CPT and ICD-9 coding of DME.
- Pleasant speaking voice and demeanor.
- Neat, professional appearance.
- Ability to perform in a highly stressful situation.
- Ability to multitask.
- Ability to focus and maintain direction in the tasks at hand under pressure.
- Ability to establish effective working relationships with patients, physicians, insurance representatives and other medical support staff.
- Background in medical terminology and orthopedics preferred.
- Ability to analyze various medical situations for scheduling purposes
