What are the responsibilities and job description for the Precertification Specialist position at US Foot and Ankle Specialists?
Precertification Specialist Position Overview:
The pre-certification specialist is responsible for pre-certification of patient appointments and procedures according to DME and diagnostic protocols.
Precertification Specialist Essential Functions/Responsibilities (other duties may be assigned):
- Pre-certify evaluation and treatment as required by insurance provider and documents appropriately for DME and diagnostic testing.
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Verify insurance eligibility and benefits online or by phone. Updates insurance policy information in EMR as required, such as completion of Notification of Benefits form.
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Verify receipt of all necessary pre-authorization documents prior to treatment.
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Communication: Effectively correspond with the team through the EMR system, email and or phone calls.
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Provide patients with estimated written documentation of covered therapy benefits per the patient’s insurance coverage Scheduling and Registration:
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Collects co-payments according to insurance plan information appointment type and documents if needed on co-pay record
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Answers patient questions and responds professionally to patient concerns, i.e., pleasant tone of voice, smile, use courteous language, etc.
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Ensures that related follow-up work is completed in a timely manner (same day or by next day), including relaying message to clinicians to return calls
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Uses Precertification protocols including insurance coverage to determine the most appropriate approach to scheduling patients
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Makes outgoing calls to reschedule appointments as needed or to provide patient reminders of appointment times and information needed for appointments, insurance cards, etc.
- Various clerical duties including copying, faxing, scanning, and filing
Precertification Specialist Required Education, Skills and Experience:
- High School Diploma/ GED equivalent
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Ability to establish and maintain effective working relationships with patients, other employees, and the public
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2 years’ admin support in a medical environment preferred
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Knowledge about health insurance, pre-authorization, insurance verification, medical terminology, CPT codes and ICD-10 codes preferred
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Must have excellent customer service skills
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Able to work in a fast-paced and demanding work environment
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Must demonstrate a strong work ethic and maintain professionalism at all times
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Must have a team mentality, flexibility and willingness to learn
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The ability to communicate effectively, multi-task and work under pressure is the key to success in this position, which also requires attention to detail and a commitment to achieving consistent customer satisfaction.
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The ability to uphold HIPAA compliance is mandatory.
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Must exercise good judgment and discretion
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Technologically savvy; proficient in Microsoft 365 products, including Word, Excel, Outlook, and Teams
Precertification Specialist Physical Requirements:
The physical demands described here represent those required to perform essential job functions. Reasonable accommodation may be made for individuals with disabilities. While performing this role, the employee must regularly:
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Sit, talk, hear, and use hands to write, type, or operate office equipment
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Occasionally reach with hands and arms; climb, balance, stoop, kneel, crouch, crawl, and smell
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Perform repetitive motions, including reaching overhead and typing
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Lift up to 50 pounds occasionally and carry objects weighing up to 25 pounds
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Maintain peripheral vision, depth perception, and focus adjustments
Precertification Specialist Benefits Offered:
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Health Insurance (Single & Family plans available)
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Life Insurance
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Disability Insurance
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401(k) plan with Company Match
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Employee Discount Program
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Paid Time Off
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Paid Holidays