What are the responsibilities and job description for the Precertification Specialist position at Watauga Orthopaedics PLC?
Job Summary
We are seeking a detail-oriented and knowledgeable Precertification Specialist to join our team. The Pre-Certification Specialist, under the supervision of the Practice Support Manager is responsible for obtaining authorizations to ensure appropriate reimbursement for services rendered is obtained. The Pre-Certification Specialist works directly with patients, referring physician offices and payers to ensure payer guidelines are met prior to receiving care.
Duties
- Responsible for obtaining in and out of network authorizations for both Physical and Occupational Therapy.
- Validates patient demographic data, identifies and verifies medical benefits and authorization requirements.
- Verifies insurance information through payer contacts, online resources or electronic verification systems and identifies payer authorization/ referral requirements.
- Provides appropriate documentation and follow up to patients and other departments regarding authorization/ referral requirements.
- Records detailed information related to authorizations/ referrals appropriately.
- Work collaboratively with insurance carriers to confirm/ verify eligibility and determine out of pocket costs as needed.
- Research and resolve with insurance payers any issues regarding pre-certifications.
- Answer calls/ questions regarding pre-cert issues.
- Additional duties as assigned.
Experience
- Previous experience in a medical or dental office setting is preferred.
- Familiarity with insurance verification processes is highly desirable.
Qualifications
- Previous pre-certification/ referral experience preferred.
- Excellent verbal and written skills.
- Strong organizational skills.
- Ability to Multi-task.
- High level of comfort and ability to maneuver web base products.
- Excellent customer service and telephone etiquette.
- Understanding of insurance benefit requirements and out of pocket costs.
- Effective problem-solving skills.
- Attention to detail.
- Good decision making.
- Computer proficiency with Windows, Outlook and Excel.
- Flexibility in cross training.
- Understands the importance of maintaining confidentiality per HIPAA guidelines.
Pay: $16.00 - $19.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- Precertification: 2 years (Required)
Work Location: In person
Salary : $16 - $19