Precertification Specialist

Borland Groover Precertification Specialist

Borland Groover is one of Florida's leading gastroenterology providers. Founded in 1947, our mission is to provide exceptional care and improve the lives of our patients. We value ourselves on delivering quality care (quality), doing the right thing (accountability), caring for our patients (compassion), and taking care of our employees (collaboration). If you love the vision of Borland Groover, and find your values aligning with ours, apply to join our team!

Position Summary

The Precertification Specialist at Borland Groover is a part of the Patient Access department. The general duty of this position is to ensure each patient has a referral and/or authorization so that the clinic and ambulatory surgical centers will be reimbursed for all services rendered.

Essential Job Functions

• Verify benefits and/or eligibility of patients that are scheduled to be seen.
• Obtain a referral as needed before a patient is seen by a physician.
• Obtain precertifications before tests and procedure(s) are performed.
• Take incoming calls from patients to help them better understand their insurance and requirements and/or to schedule or reschedule patient appointments as needed.
• Conduct outbound calls to patients as necessary.
• Complete payment arrangements for patients when necessary.
• Contact insurance companies to inquire about benefits or authorizations requirements.
• Assist the satellite office personnel with insurance or precertification comprehension as needed.
• Answer nurse or patient portal inquiries assigned to the department.
• This job requires access to Personal Health Information (PHI), HIPAA training is required, and HIPAA compliance is expected.
• Must follow the organization's Code of Conduct.
• Must participate in the Compliance Program Initiatives and reporting and Compliance Issues.
• Handle all other duties as assigned.

Competencies

• Communication - Exhibits good listening and comprehension. Expresses ideas and thoughts in written form. Expresses ideas and thoughts verbally. Keeps others adequately informed. Selects and uses appropriate communication methods
• Critical Thinking and Problem Solving - The ability to handle complex situations in the workplace and calmly develop creative solutions.
• Compassion - Exhibits empathy or real concern for patients coupled with a desire to take action to address the patient's needs.
• Time-Management - The ability to plan your duties ahead of time and leveraging technology to help you do so efficiently.

General Qualifications

• Ability to communicate effectively with patients, physicians and staff both verbally and in writing.
• Works well with patients, physicians, and staff.
• Attention to detail.
• Ability to handle multiple tasks in a possibly stressful environment.
• Ability to handle patient issues in a tact, professional way.

Education and Experience

• High School diploma required.
• Previous experience preferred but not required.

Physical Requirements

• Sitting: Prolonged periods of sitting at a desk and working on a computer: essential
• Moderate lifting (15-20 lbs.): essential
• Walking: Must be able to access and navigate each department at the organization's facilities: essential
• Pushing/Pulling: marginal
• Standing: essential
• Repetitive motion: marginal
• Reaching: marginal
• Bending: marginal

Emotional Demands

• Fast pace: essential
• Multiple Stimuli: essential
• Intense customer interaction: essential
• Frequent change: essential

Mental/Sensory Demands

• Memory: essential
• Reasoning: essential
• Hearing: essential
• Reading: essential
• Analyzing: essential
• Logic: essential
• Verbal communication: essential
• Written communication: essential

Benefits (Full-Time Employees)

• Health Insurance
• Dental Insurance
• Vision Insurance
• 401K Retirement Plan
• Life Insurance
• Short- and Long-term disability
• Profit Sharing
• Supplemental Insurance
• Education and Tuition Reimbursement funding
• Initial Uniform Allowance
• Employee Assistance Program (EAP)
• Paid Time Off (PTO)
• Volunteer Time Off (VTO)
• Paid Holidays

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhausted list of duties, responsibilities, and skills. Borland Groover is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We thank all applicants for their interest, however only those selected for an interview will be contacted.