Who We Are

American Pain Consortium’s mission is to empower providers to deliver exceptional patient care.

As an employer, our mission is to empower every member of our team to realize their maximum professional potential and create an environment conducive to our shared success. As we look to partner with providers and add value, we also look to add value to our growing team by hiring the brightest minds in the business. We truly understand that our most valuable assets are our team members. American Pain Consortium started in 1993 with a passionate physician who has built a team of leaders to committed to developing the company around passionate, career-driven people and we are proud to boast an organization comprised of them. APC is seeking an individual who is eager to learn, develop, and grow in a role in the Pre-Service Department located in the Support Office in Fairfield, OH.

Job Summary

The Pre-certification Specialist is responsible for obtaining insurance pre-certification prior to the rendering of medical services. This includes obtaining accurate demographic information, validating insurance information including eligibility, medical policy, and benefits as needed. Answers and provides resolution for any questions received from patients, providers, visitors, and staff.

Essential Duties & Responsibilities (What You’ll Do)

· Obtains insurance pre-certification prior to patients receiving medical services, ensuring accuracy, and timeliness

· Documents critical authorization information to ensure claims payment

· Verifies completeness including accurate patient status, CPT code, ICD-10, and other components as necessary. Follows up with applicable staff to obtain correct orders and clinical information that supports medical necessity for services being rendered.

· Ensures departmental compliance: auditing physician orders compared to actual scheduled procedure for accuracy and completeness

· Resolves patient issues in a concise and informative manner notifying applicable staff, providers, and patient of authorization denial or downgrade of procedure.

· Performs timely pre-certification, authorization, and verification of insurance coverage, considered as 7 working-days out from patient appointment or within payer timeframes.

· Maintaining up-to-date working knowledge of current medical policies of all payors

· Answering and providing resolution for any questions received from patients, visitors, providers, and staff.

· Meets department goal of data accuracy using the appropriate insurance authorization website or verifying by phone 100% of the time.

· Participate in continuous process improvement activities

· All other duties as assigned

Minimum Qualifications (What We Are Looking For)

• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with Microsoft Office Suite or related software.
• Solid understanding of healthcare terminology
• Able to distill patient financial information and present essential information in a clear and concise manner
• Self-directed and able to work independently
• Hands- on style with the desire and ability to command details.

Education and/or Experience Requirements

• High School Diploma
• Preferred Minimum of 24 months administrative experience in a medical facility, health insurance, or related area preferred
• Prior scheduling, pre-certification, and medical terminology required
• Knowledge of function and relations within a healthcare clinic environment required.
• Experience with Ohio Workers Comp (BWC) and Implantable Devices is preferred.

Competencies

To perform the job successfully, an individual should demonstrate the following, which is included, but not limited, to:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service - Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
• Respect for Others - Treats patients, physicians, and colleagues in a professional, respectful, compassionate manner
• Respect for Privacy - Handles all patient, company, and staff information in a confidential manner compliant with all state and federal regulations and the APC Code of Conduct.

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standing and/or walking 10% of time
• Sitting 90% of the time
• Occasional lifting, stooping, kneeling, crouching, and reaching

Supervisory Responsibilities

This position has no supervisory responsibilities

Benefits (Work Perks)

Included for all full-time positions

• Medical, Dental, and Vision Insurance
• Paid Time Off
• Paid Holidays
• Matching 401K plan
• Other

Equal Employment Opportunity

American Pain Consortium Management, its affiliates, and subsidiaries are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, protected veteran status, national origin, sexual orientation, gender identity or expression (including transgender status), genetic information or any other characteristic protected by applicable law.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Weekly day range:

• Monday to Friday

Application Question(s):

• What are your salary expectations?
• Will you be able to reliably commute to Fairfield, OH for this job?

Education:

• High school or equivalent (Required)

Ability to Relocate:

• Fairfield, OH 45014: Relocate before starting work (Required)

Work Location: In person