What are the responsibilities and job description for the PRECERT SPECIALIST position at SportsMED Orthopaedic Specialists?
SportsMED Orthopaedic Surgery & Spine Center in Huntsville, AL, is seeking a Precertification Specialist to join our Billing and Insurance Team.
The Precertification Specialist reports to the Precertification Supervisor. Under indirect supervision, the Precertification Specialist performs pre-certification functions to ensure that all services requiring carrier authorizations are approved.
The duties associated with this role include but are not limited to:
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Verify insurance benefits and coverage for upcoming procedures and surgeries.
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Obtain precertifications and authorizations from insurance carriers in a timely manner.
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Communicate with physicians, clinical staff, and patients regarding authorization statuses and insurance requirements.
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Document all communication and authorizations in the EMR system accurately.
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Track pending authorizations and follow up as needed to ensure approvals are received before scheduled services.
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Stay current with payer policies, coding guidelines, and insurance verification protocols.
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Serve as a liaison between patients and insurance providers to answer questions or resolve issues.
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Coordinate with billing and scheduling departments to ensure all procedures are cleared before the date of service.