What are the responsibilities and job description for the Surgical Pre-Certification Representative position at Rothman Orthopaedics?
Job Details
Description
Rothman Orthopaedics is looking for a Surgical Pre-Certification Representative to join our team! The Pre-Certification Representative ensures accurate, efficient processing and interaction with all insurance companies and staff with regard to pre-certification. If you are qualified for and interested in this role, please apply.
Job Title: Surgical Pre-Certification Representative
Hours: Mon - Fri: 8am - 5pm (will work 40 hrs/wk)
Location: will train on site at 833 Chestnut St, Philadelphia, PA
- will work remotely after training
Job Qualifications:
- High School diploma or GED minimum education requirement
- 1 years of pre-certification experience required
- Must have familiarity and experience with medical insurances
- Computer skills including, but not limited to, MS Office and EMR system(s)
Job Duties:
- Processes all incoming requests for pre-certification and authorization for upcoming procedures being performed by a physician or department at Rothman Institute. Reviews all requests for appropriate information required to get approval and accurate benefit information.
- Reviews physician schedules prior to scheduled procedures to ensure all have been pre-certified or authorized.
- Reviews benefits to ensure patient has adequate coverage and communicates high out-of-pocket expenses to the Financial Counseling team.
- Notates patient's account with all information relevant to the authoirzation and pre-certification process, including filling out Structured Data fields in eCW referral.
- Faxes/uploads required pre-certification paperwork to insurance company, adjuster or medical review department to ensure authorization is obtained.
- Responsible for pre-certification process in its entirety, including communicating denials and initiating appeals.
- Manages all workers’ compensation and auto pre-certifications due to additional time required by these payers to obtain approval.
Our Commitment to Employees:
Come work at Rothman Orthopaedics! Our employees are our single greatest asset, as such, we strive to provide a professional, nurturing environment where every member of our team can make a meaningful difference in the lives of others. This commitment to our employees has earned us the distinction as a Top Workplace in Philadelphia by the Philadelphia Inquirer year after year. Our employees enjoy competitive pay, comprehensive health and dental benefits, tuition reimbursement, paid time off, and retirement savings plans.
Rothman Orthopaedics is an Equal Opportunity employer committed to providing opportunities to all qualified applicants without regards to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. We value developing an inclusive and equitable environment that strengthens our organization and allows us to better attract and retain a diverse workforce that is representative of our patients and our community. We model our values by creating and enacting practices that encourage participation from all backgrounds, perspectives, and experiences.
COVID-19 Policy:
As a condition of employment at Rothman Orthopaedics, it is required you receive the COVID-19 vaccination. Rothman Orthopaedics is an Equal Opportunity Employer and requests for reasonable accommodations will be considered.
