Pre-Certification Specialist

US Heart and Vascular will be adding a Pre-Certification Specialist to our team at Orion Medical in Houston, TX. This role is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorizations process with all commercial payers.

Responsibilities & Duties:

• Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
• Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
• Coordinates and supplies information to the review organization (payer) including medical record information and/or letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Communicates with patients, clinical partners, financial counselors, and others as necessary to facilitate the authorization process.
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner.
• Completes accurate documentation in all applications.
• Follows departmental policies and procedures, when necessary, authorization is not obtained before the service date.
• Answers provider, staff, and patient questions surrounding insurance authorization requirements.
• Provides excellent customer service when communicating estimated costs with patients by phone, email, text, etc.

• Familiarity with medical office procedures and billing practices
• Proficient in clinical documentation review for alignment with insurance authorization requirements
• High School Diploma or equivalent required
• Associate's degree in healthcare administration or business administration preferred
• Minimum of 1-3 years' experience in the same role, or related field in a healthcare setting is required.