Pre Certification Collection Specialist

Pre-Certification Collection Specialist

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement.

We are currently searching for a Pre-Certification Collection Specialist to join our Utilization Review team in the OrthoCarolina Business Office in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs.

The Pre-Certification Collections Specialist serves as liaison between the patient, insurance company, physician, and facility. There is a large volume calling patients and insurance companies. Other duties include:

Essential Functions:

• Confirming eligibility, benefits and precertification with insurance carriers for patient's scheduled with Physician and facility.
• Responsible to pre-collect from patients including unpaid, true patient current balance, patient's estimated financial responsibility up to and including entire Out of Pocket when necessary.
• Responsible for tracking the account from notification of scheduled appointment including same day and next day add-ons for authorization as well as pre-collection of patient financial responsibility.
• Responsible for identifying and correcting internal problems within assigned accounts to expedite payments from insurance companies.
• Responsible for using online tools for benefits, reviewing medical criteria/policy, prior plan approval (PPA) requirements, initiating and obtaining authorizations

Skills and Abilities:

• Must have knowledge of physician, facility and hospital pre-certification.

Qualifications

Accounts Receivable (AR), Customer Service, Data Entry, Documentations, Office Management, Patient Account Management, Patient Care, Payment Analysis