Pre-Authorization specialist

Job Summary:

Perform insurance pre-certification duties for surgical procedures, MRI scans, and injections. Make payment arrangements for estimated patient responsibility for surgical procedures, MRI scans, and injections per policy; provide excellent patient services via telephone and in person.

Essential Duties & Responsibilities:

Correct Insurance Company

• Obtain correct insurance company information such as Workers' Compensation vs. commercial insurance, including telephone number and policy numbers from system.

Pre-Certification/Pre-Authorization

• Contact insurance companies to obtain pre-certification for all outpatient surgical procedures, inpatient surgical procedures, short-stays, MRI and CT scans, and injections, if required by the insurance plan.

Insurance Benefits

• Obtain insurance benefit information and calculate pre-surgical payments for all surgical procedures performed at all locations and for all MRIs performed at Premier Bone and Joint Centers' locations.

Contact Patient

• Contact patients regarding estimated patient responsibility amounts for all surgical procedures, MRIs, and injections scheduled at all Premier Bone & Joint Centers' locations, review all outstanding balances with patients, and design payment arrangements if necessary.

Surgical Charts

• Assemble ASC surgical charts and deliver the charts to the front desk the day before the scheduled surgical procedure.

Pre-Payment Information

• Provide pre-payment information to the front desk staff.

Insurance Carrier Tools

• Use insurance carrier tools to estimate patient out-of-pocket costs.

Insurance Contractual Discounts

• Knowledge of insurance contractual discounts.

Insurance Provider Policy Knowledge

• Knowledge of insurance provider policies and procedures regarding patient claims.

Medical Terminology Knowledge

• Knowledge of medical terminology and basic human anatomy.

Interpersonal Skills:

Working Relationships

• Ability to establish and maintain effective working relationships with physicians, co-workers and the public that harbor a friendly, yet professional interaction. Demonstrate willingness to readily interact with other staff members and department.

Mentor

• Acts as a mentor for new employees.

Personal Growth

• Accepts responsibility for own professional growth and personal conduct by seeking knowledge in work specific areas, taking advantage of opportunities at work to observe and volunteer.

Flexibility and Stressful Situations

• Ablility to be flexible, organized, and function under stressful situations.

Adherence to Facility/Departmental Policy:

Confidentiality

• Observe confidentiality of information in regards to patients, physicians, and fellow employees; ability to maintain confidentiality under HIPAA standards.

Attendance/Punctuality

• Maintains a good attendance record and arrives to work punctually.

Overtime

• Able to substantiate overtime, minimizes overtime and adjusts hours as needed.

Dress Code/Identification

• Follow dress code of the department, appear professional when present in the clinic, wear identification while on duty, and communicate name and role to patient appropriately.

Cell Phone Use

• Cell phone may be used for business purposes only. Utilizes cell phone for personal use only during breaks or meal periods out of the public eye.

Staff Meetings/In-services

• Participates in Premier Bone & Joint Centers and departmental in-services and staff meetings.

Safety & Infection Control Policies

• Adhere to safety and infection control policies.

Care of Environment, Equipment, and Supplies:

Clean, Neat, Safe Environment

• Maintain a clean, neat, and safe environment for patients and staff, including personal work areas.

Office Equipment Skills/Malfunctioning Equipment

• Utilizing correct/safe technique when using equipment and notify manager of malfunctioning equipment.

Requirements

Education:

• High School Diploma or Equivalent General Required

Experience:

1 Year - Business Office Type Experience - Preferred

Physical Requirements:

Seeing - Must be able to read reports and use a computer - Constant

Hearing - Must be able to hear well enough to communicate with patients, physicians, administrative staff, insurance companies, and co-workers - Constant

Speaking- Must be able to verbally communicate with patients, physicians, administrative staff, insurance companies, and co-workers - Constant

Grasping - Must be able to write and type - Constant

Standing - Rarely

Sitting - Frequently

Weight Demands:

Lifting - Must be able to lift 10 pounds or less - Occasionally

Working Conditions:

Environmental Hazards

• The fast paced environment may lead to increased levels of personal stress and demand high mental acuity.

Physical Hazards

• Physical harm is possible when performing physical requirements, as listed above.
• Exposure to communicable disease, bodily fluids, and/or toxic substances is possible and can be physically harmful.

Unique Work Schedule/Travel

• May be required to work after hours, on weekends, or holidays.
• May be required to provide services outside the clinical setting (i.e. at University or High School athletic events), or travel to offices throughout the state.

Employee Statement of Understanding:

I have read and understand the job description for my position. I am able to perform all of the essential functions of this position.

I agree to comply with the corporate compliance policy and all laws, rules, regulations and standards of conduct related to my position. As an employee, I understand my duty to report any suspected violations of the law or the standards of conduct to my immediate supervisor.

As an employee, I will strive to uphold the mission and vision of the organization. All employees are required to adhere to the values in all their interactions with patients, customers, and fellow employees.

Note: This description is intended to describe the general job duties and employment requirements for adequate job performance, and should not be interpreted as an exhaustive report. Additional duties and responsibilities may be assigned at the discretion of the employees' supervisor.