Precertification Specialist
Columbia Orthopaedic Group
Date: 2 weeks ago
City: Columbia, MO
Contract type: Full time
Job Summary
A Precertification Specialist is responsible for obtaining authorizations for all procedural orders with all insurance payers, as well as checking benefits and collecting payments for upcoming appointments.
Duties/Responsibilities
A Precertification Specialist is responsible for obtaining authorizations for all procedural orders with all insurance payers, as well as checking benefits and collecting payments for upcoming appointments.
Duties/Responsibilities
- Review chart documentation to ensure patients meet 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, including up-to-date requirements needed to successfully obtain 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, benefits, and payment expectations for upcoming appointments.
- Assist in verifying insurance benefits, including deductible and copayment amounts, to inform patients of their financial responsibilities.
- Collect payment information and facilitate payment arrangements as needed prior to scheduled procedures.
- Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle.
- Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
- 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, especially regarding financial discussions with patients.
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
- Work well within a team environment and be able to work flexible hours as needed.
- High School Diploma or GED (required).
- 2 years of medical authorization experience, preferred.
- 2 years of experience in a medical-related field, preferred.
- Prolonged periods of sitting at a desk, working on a computer, and answering phones.
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