Precertification Specialist

Description

Job Summary:

The Spine Team Texas Precertification Specialists are responsible for obtaining pre-certification for surgeries and/or injections in a timely manner and as required.  Position will provide support to collections team when necessary to obtain proof of insurance requirements necessary to obtain payment for claims.  Position will also assist the Eligibility Coordinator in obtaining benefit information on new and established patients.  This position requires the full understanding and active participation in fulfilling the mission of Spine Team Texas.  The Precertification Specialist reports directly to the Patient Financial Services Manager who is under the direction of the Business Office Director.

Spine Team Texas Attributes

In order for Spine Team Texas to meet the goals expressed through the company mission statement, it is imperative that all employees possess the following attributes:

1. Knowledge – The blending of job related education, skills and experience.
2. Quantity – Level of satisfactory output generated in position per unit time.
3. Accuracy – Absence of errors.
4. Judgment – Capacity to make reasonable decisions.
5. Innovation – Imagination and creativity used to better position.
6. Appearance & Habits – Personal habits, grooming, uniform / clothing.
7. Orderliness – Organization of the individual’s work and work area.
8. Courtesy – Respect for feelings of others.  Politeness on the job.
9. Cooperation – Willingness to help others accomplish their objectives.
10. Initiative – Voluntarily starting projects.  Attempting non-routine jobs and tasks.
11. Reliability – Dependability and trustworthiness.
12. Perseverance – Steadfast pursuit of job objectives when faced with unexpected obstacles.
13. Stability – Even temperament. Acceptance of unavoidable tension and pressure.
14. Alertness – Ability to quickly understand new information and situations.
15. Professionalism – Professional actions, communications and attitude.
16. Team work – Ability to work in a team for the betterment of staff, patients, and the Company.
17. Observance – Observance of Company policies and procedures.
18. Attendance – Consistent adherence to work schedule.

Job Responsibilities:

1. The Precertification Specialist will be responsible for reviewing all orders to obtain the required precertification for surgeries, injections, and MRIs. In addition, communicating back to Procedure Schedulers when an order has not been completed so a precert can be obtained.
2. Precertification is responsible for contacting all insurance companies to obtain the pre-certification reference number for any surgeries and/or injections that are to be performed. 
3. The Precertification Specialist must accurately post pre-certification numbers in case management. In addition, she will provide support to collections team when necessary to obtain proof of insurance requirements necessary to obtain payment for claims. 
4. Other duties and responsibilities may be assigned by the Patient Financial Services Manager.

Customer Service

All Spine Team Texas employees are required to maintain the highest level of customer service at all times.  Employees must always speak in a kind, courteous and professional manner when dealing with a patient/customer or co-worker.  Employees are required to fulfill the Spine Team Texas mission of “Offering an Unparalleled Patient Experience!”  All employees must exhibit a spirit of cooperation and positive attitude.  Professionalism is to be maintained at all times.

Team Concept:

Spine Team Texas was founded on a team concept approach.  To build and enhance the team, each employee must contribute positive interaction, promote value and be a “team-player” not only for their unit or department, but for Spine Team Texas as a whole.

Physical Requirements & Work Environment

Must be able to sit for long periods of time in a well-lit, air conditioned office environment.  Must have ability to lift a minimum of 5 pounds.  Must be able to work under pressure.  Tasks involve no exposure to blood or other potentially infectious materials.

Qualifications

Educational Requirements & Position Qualifications:

1. High School diploma or equivalent is required.
2. Minimum of 3 years Medical Billing or pre-certification experience required.
3. Detail oriented and organizational skills.
4. Computer experience, typing and ability to operate calculator.
5. Ability to effectively communicate with patients and insurance carriers.
6. Possess the ability to work productively, either independently or with other individuals.
7. Possess the ability to plan and execute work projects.
8. Proficient in communicating in the English language both written and verbally.

Coding Certificate or knowledge preferred