1 Pre-Certification Specialist - San Marco Job in Jacksonville, FL

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Pre-Certification Specialist - San Marco

Jacksonville Orthopaedic Institute

Jacksonville, FL | Full Time

$44k-59k (estimate)

3 Weeks Ago

Pre-Certification Specialist - San Marco

$44k-59k (estimate)

Full Time 3 Weeks Ago

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Jacksonville Orthopaedic Institute is Hiring a Pre-Certification Specialist - San Marco Near Jacksonville, FL

Jacksonville Orthopaedic Institute is in search of a Pre-Certification Specialist to work at the San Marco clinic on San Marco Blvd.

This position is full-time with benefits including medical, dental, vision, life, disability insurance, and a 401K retirement plan.

Schedule: Monday - Friday

Location: 1325 San Marco Blvd, Jacksonville, FL 32207

The Precertification Specialist is responsible for obtaining prior authorizations for all surgical orders for the

San Marco and South clinic by successfully completing the authorization process with all commercial payers.

Essential Functions:

Review chart documentation to ensure patient meets 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 to include up to date requirements needed to successfully obtain authorizations
Initiate appeals for denied 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
Other duties as assigned

Position Requirements:

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
2 years medical prior authorization experience preferred
2 years experience in a medical related field required
Proficient use of CPT and ICD-10 codes
Excellent computer skills
Detail oriented with above average organizational skills
Plans and prioritizes to meet deadlines
Excellent customer service skills; communicates clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
High School Diploma or GED

Physical Demands:

Requires sitting 80%, standing 10%, walking 10%.
Requires manual dexterity sufficient to operate a keyboard, mouse and multiple telephone lines.
It is necessary to view computer screen for long periods of time.