Precertification Specialist
Gahanna-OH-43230-United States
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POSITION SUMMARY
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Responsible for pre-certification of patient appointments and procedures according to Therapy Services protocols. Interactions with patients and insurance companies must be courteous, professional and efficient.
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RESPONSIBILITIES AND ACCOUNTABILITIES
- Pre-certification:
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Timely verification and/or pre-certification for evaluation and treatment as required by insurance provider and documents appropriately. Verify primary and secondary insurance coverage for both in/out of network benefits.
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Verify insurance eligibility and benefits online or by phone which necessitates long periods of time on telephone with insurance representatives.
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Verify co-pays, deductibles, co-insurance, covered and non-covered services.
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Re-verifies existing patient insurance coverage annually or as required.
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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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Receives referrals and enters information into EMR including authorization numbers, PCP information, visits allotted and expiration date or any other notes pertaining to insurance plan.
- Documentation:
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Document clear and concise benefit information into the EMR system.
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Coordinates and reviews information with staff so they can review benefits with patients
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Provide patients with estimated written documentation of covered therapy benefits per the patient’s insurance coverage
- Business Office/Billing:
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Collects patient and insurance information required to update EMR and patient record including photocopying or scanning insurance cards.
- Clerical
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Scan and file documents into EMR including NOB and insurance verification documents
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Various clerical duties including copying, faxing, scanning, and filing
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Other duties assigned in support of clinicians or physicians
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TEAMWORK
- Teamwork:
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Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.
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Works cooperatively and refrains from participating in negative conversations.
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Shares knowledge and insights with co-workers in a constructive manner.
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Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.
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Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.
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POLICIES AND PROCEDURES
- Policies and Procedures
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Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
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Provides assistance and support to leadership in implementing policies and procedures as necessary.
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Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.
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QUALIFICATIONS
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Education, Experience, Certification and Licensure Requirements:
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High School Diploma or equivalent required. Customer service experience and basic computer skills required, preferably in a windows environment with electronic medical records software. Medical terminology or other previous medical office experience desirable. Precertification experience required. Must maintain CPR/AED certification.
PI275652255
