Precertification Specialist

Job Responsibilities

• The Precert/Verification Specialist will be responsible for reviewing all orders to obtain the required precertification for surgeries, injections, and MRIs. In addition, communicating back to Procedure Schedulers when an order has not been completed so a precert can be obtained.
• This position is responsible for contacting all insurance companies to obtain the pre-certification reference number for any surgeries and/or injections that are to be performed.
• The position must accurately post pre-certification numbers in case management. In addition, she will provide support to collections team when necessary to obtain proof of insurance requirements necessary to obtain payment for claims.
• The Precert/Verification Coordinators are responsible for obtaining benefit information for all new patients and established patients that have not had insurance verification within 90 days and perform this task in a timely manner and as required. A) Benefit information consist of Deductible amounts both in and out of network, whether the deductibles cross over, Out of Pocket amounts both in and out of network, benefits for Physical Therapy, co-payments, and co-insurance. Documentation is required in the Patient Registration and Insurance Eligibility box. Position will communicate closely when necessary with the Scheduling Coordinators for East and West locations and the Patient Service Associates located in each clinic when stat verifications arise or information is lacking from the patient to complete the verification process.
• Other duties and responsibilities may be assigned by the Patient Financial Services Manager.
  
  

Customer Service

All Spine Team Texas employees are required to maintain the highest level of customer service at all times. Employees must always speak in a kind, courteous and professional manner when dealing with a patient/customer or co-worker. Employees are required to fulfill the Spine Team Texas mission of Offering an Unparalleled Patient Experience! All employees must exhibit a spirit of cooperation and positive attitude. Professionalism is to be maintained at all times.

Educational Requirements & Position Qualifications

• High School diploma or equivalent is required.
• Minimum of 3 years Medical Billing or pre-certification experience required.
• Detail oriented and organizational skills.
• Computer experience, typing and ability to operate calculator.
• Ability to effectively communicate with patients and insurance carriers.
• Possess the ability to work productively, either independently or with other individuals.
• Possess the ability to plan and execute work projects.
• Proficient in communicating in the English language both written and verbally.
  
  

Coding Certificate or knowledge preferred