PreCertification Financial Specialist

DUTIES AND RESPONSIBILITIES

• Manage and monitor assigned surgical cases and workflow tasks, ensuring timely completion of insurance verification, precertification, and authorization activities.

• Verify insurance eligibility, benefits, and coverage limitations through payer portals and direct payer contact, and accurately document findings in ModMed.

• Review payer medical necessity guidelines and reimbursement policies to determine authorization and precertification requirements for scheduled procedures.

• Obtain and track prior authorizations and precertifications for surgical and clinical services to ensure compliance and prevent denials or cancellations.

• Accurately enter and maintain authorization numbers, approval dates, and supporting documentation in ModMed.

• Confirm receipt and completeness of all required clinical documentation and authorization approvals prior to scheduled procedures.

• Serve as a liaison between providers, surgery coordinators, ambulatory surgery centers (ASC), and external facilities regarding authorization and financial clearance.

• Prepare and communicate patient financial estimates, including procedure codes, anticipated charges, and out-of-pocket responsibility.

• Provide pre-operative financial counseling, educating patients on insurance benefits, deductibles, coinsurance, and payment expectations.

• Assist patients with financial assistance options, payment plans, or alternative funding resources when applicable.

• Collect required pre-payments for clinic and ASC services in accordance with organizational policies.

• Post, reconcile, and balance patient payments in ModMed; generate and review daily transaction reports for accuracy.

• Coordinate with Patient Accounts and Billing teams to resolve past-due balances prior to elective procedures.

• Notify patients of outstanding balances and pre-payment requirements related to elective surgical services.

• Process credit card and electronic check payments using approved payment platforms and procedures.

• Identify and resolve coding discrepancies to ensure accurate procedure documentation prior to authorization submission.

• Maintain consistent communication with Patient Access, scheduling, and clinical teams to support operational continuity.

• Provide cross-coverage and team support as needed to maintain department productivity.

• Perform additional duties as assigned to support Patient Access and revenue cycle operations.

Associate must have excellent customer service skills and be very positive and enjoy working hard to achieve company goals. Excellent phone and follow up skills are a requirement. A high school diploma is required, some college preferred. Experience with medical insurance pre-certification is required with knowledge of CPT/ICD10 coding. Associate needs to have mathematical ability to calculate co pays and deductibles. Experience with web based eligibility systems and proficiency in web based benefit software preferred.