BUSINESS SPECIALIST

Responsible for Claims Poster, Pre-certification and Switchboard duties.

Claims Poster Position Overview: Responsible for posting all insurance and patient payments to the correct accounts within established time frames. The Claims Poster will review payments that are auto posted and payment posted manually to ensure the data entered into the Practice Management system matches the EOB or other remittance advice.

Claims Poster Responsibilities:

• Posts payments (electronic, care credit, cash, check, credit cards)
• Updates claim posting reports as assigned
• Read EOB and processes payment according to allocations listed
• Balance batch totals daily
• Submit batches and reports to supervisor
• Verifies all EOBs paid and non-payments have been distributed to PARs
• Responds to research requests from PARs or other departments regarding payments
• Assist Patient Account Representatives in resolving payment posting issues and complete all Patient Account Representatives
• Contact insurance companies in order to resolve unapplied
• Ensures all claims are posted to the correct patient account and
• Demonstrate and apply basic knowledge of posting and applying multiple deposits and insurance payments such as lockbox, insurance, EFT, patient, credit card, and

Pre-certification Position Overview: Performs pre-certification functions to ensure that all services requiring carrier authorization are approved. The Pre-certification Specialist will call insurance companies, adjusters, and patients to complete the precertification and prior authorization process. Responsibilities include communicating the approval or denial of surgeries and/or tests to physicians, physicians' staff, surgery center, and patients.

Pre-certification Responsibilities:

• Responsible for obtaining precertification and prior authorization for patients scheduled for a surgical procedure and/or tests as ordered by
• Responsible for obtaining all necessary information required to obtain precertification or prior authorization to include clinical dictation and test
• Provide accurate information to insurance companies based on test results, clinical dictation,
• Verify/re-verify insurance benefits and eligibility for each scheduled surgical procedure and/or test.
• Complete precertification and prior authorization process in a timely, efficient manner with respect to urgent requests

Switchboard Operator Overview: The Receptionist/Switchboard Operator is responsible for answering the main switchboard in a professional and timely manner and will respond to routine questions, forward calls to appropriate departments and/or individuals, take clear and accurate messages when necessary and ensure all staff are informed of their messages.

Pre-certification Responsibilities:

• Exhibits excellent customer
• Knowledgeable of all office locations, physician schedules and
• Provides directions to offices as
• Responsible for assessing callers' questions, responding when appropriate, and transferring calls to the best resource for further assistance as