What are the responsibilities and job description for the Pre-Certification Specialist position at Southeastern Spine Institute, LLC?
Position: Pre-Certification Specialist
Department: Finance
Reports to: Reimbursement Director
FLSA Status: Non-exempt
Pay Type: Hourly
Position Type: Full-time
Effective Date: January 31, 2024
Position Summary:
Responsible for working directly with insurance companies and obtaining approval for various procedures scheduled by SSI providers.
Working Conditions:
Sitting, standing, walking, bending, stooping, twisting, reaching overhead and lifting up to 40lbs.
Primary duties include, but are not limited to:
- Review chart documentation to ensure patient meets medical policy guidelines
- Prioritize incoming authorization requests according to urgency
- Obtain authorization via payer website or by phone and follow up regularly on pending cases
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
- Initiate appeals for denied authorizations
- Respond to clinic questions regarding payer medical policy guidelines
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status
- Other duties as assigned
- Per-certify all Practice procedures
- Verify benefits for patients
- Work with Receptionist and Medical Assistants on schedule conflicts, benefits and deductibles, and surgery patients
- Report denials to Medical Assistants
- Calculate percentages for payments and report amounts to be collected
Position Requirements:
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
- Understanding of payer medical policy guidelines
- Basic understanding of human anatomy, specifically musculoskeletal
- Proficient use of CPT and ICD-10 codes
- Excellent computer skills including Excel, Word, and Internet use
- Detail oriented with above average organizational skills
- Plans and prioritizes to meet deadlines
- Excellent customer service skills; communicates clearly and effectively
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
EDUCATION/EXPERIENCE REQUIRED
- High School Diploma or GED
- 2 years medical prior authorization experience preferred
- 2 years experience in a medical related field required