Pre-Cert Specialist - Fondren

Company:        Fondren Orthopedic Group A Division of OrthoLoneStar

Title:                Precertification Specialist

Basic Responsibility

The Precertification Specialist is responsible for patient insurance benefits including verification and authorizations. Verifies and analyzes insurance coverage plan for patients upon referral/admission. Communicates plan information to appropriate parties. Provide accurate and complete data input for precertification requests, and ongoing authorizations.

Specific Responsibilities

The specific responsibilities of the Precertification Specialist encompass but are not limited to the following:

• Analyzes and verifies patient insurance coverage and determines payer priority for all potential insurance and private pay coverage
• Obtains prior insurance authorization
• Reviews requests made by physicians and other authorized medical staff for additional authorized units under established guidelines
• Initiates prior and post authorization requests via fax transmission, online submission and/or telephone contact
• Returns calls back to insurance providers with precertification numbers as needed and file completed precertification requests as per established protocols
• Ensures that all prior authorizations and ongoing authorizations documentation, databases and records are maintained clearly, accurately within a timely manner, and meets HIPAA requirements

Skills Required:

• Working knowledge of insurances for authorization and appeals requirements
• Knowledge of Microsoft Office applications which may include Outlook, Word, and Excel
• Excellent customer service and professionalism to resolve complex payer coverage issues
• Good knowledge of general office practices and procedures
• Excellent organizational and analytical skills
• Excellent oral and written communication skills, strong interpersonal skills, and ability to work in an autonomous and independent manner
• Knowledge of HIPAA requirements

Minimum education and work experience requirement:

• High school diploma.
• Prior experience with billing processes, prior authorizations, billing systems, knowledge of different insurance plans and ability to research complex issues.

Reports to:     Pre-Cert Supervisor