Accounting, Anatomy, Billing, Communication Skills, Current Procedural Terminology (CPT), Customer Support/Service, Detail Oriented, Documentation, Financial Management, Health Insurance, Health Plan, Insurance, International Classification of Diseases (ICD), Managed Care, Medical Billing, Medical Terminology, Organizational Skills, Past Due Accounts, Physical Demands, Physiology, Primary Care, Surgical Procedures
POSITION SUMMARY: The Pre-Certification & Insurance Specialist is responsible for verifying patient insurance eligibility and benefits, obtaining prior authorizations, and coordinating pre-certification requirements for scheduled procedures. This position provides patients with procedure estimates, explains financial responsibilities, collects pre-payments when appropriate, and serves as a resource for insurance and billing questions. Success in this role requires exceptional attention to detail, strong communication skills, and a commitment to providing an excellent patient experience.
WHAT WE OFFER:
- Starting wage of $15 - $19 per hour based on previous experience
- 6.5 paid holidays per year + 2 floating holidays
- Approximately 8 days of PTO within first year
- Full slate of benefits to include health, dental, vision, and 401k
- Growth and wage increase through company paid certification program
ESSENTIAL RESPONSIBILITIES:
- Monitor scheduled surgeries and maintain organized list with status of pre-certification process.
- Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in Eyecare as required.
- Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
- Verify receipt of all necessary pre-authorization documents prior to procedure.
- Communicate effectively with the facility in which the procedure will be performed as needed.
- Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
- Notify primary care physician for managed care plans that require PCP authorization.
- Supply patients with written or verbal estimates of surgical codes and fees upon request.
- Meet with patients pre-operatively or communicate effectively as necessary with patients so they understand the billing process and their financial expectations pre-operatively.
- Collect pre-payment from the patient when necessary.
- Notify patients with past due accounts of pre-payment policy for elective surgery. Receive payments from patients.
- Assist with check-in and check-out when needed. Serve as a resource on insurance, billing and customer service for reception and cashier.
- Monitor cash box and report balance to supervisor and accounting department monthly.
- Perform other duties or functions as assigned.
EDUCATION AND/OR EXPERIENCE:
- A minimum of two (2) year's experience in the medical field.
- Must have a strong knowledge of anatomy, physiology, medical terminology, and medical insurance.
PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA guidelines):
- Physical Activity: Talking, Hearing, Repetitive motion.
- Physical Requirements: Sedentary work. Involves sitting most of the time.
- The worker is required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.