Pre-Certification Medical Authorization Specialist - Remote
Position Overview:
As a Pre-certification Specialist, you will be responsible for communicating and maintaining information flow in the managed care referral process for contracted health plans.
Essential Duties & Responsibilities:
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Oversee the managed care in-patient and outpatient referral and pre-authorization process
-
Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process
-
Maintain referral and authorization records documentation
-
Verify insurance for in-network eligibility and benefits
-
Field calls for prescription benefits questions and prescription verification
-
Contact referring physicians and secure authorizations for treatment
-
Communicate with hospitals to obtain pre-certification numbers
-
Maintain strict confidentiality required related to medical records and other data
-
Participate in professional development opportunities to stay current with health care practices and trends
-
Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office
-
Other duties as assigned
Required Skills:
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High school diploma or equivalent, college courses, or certificate preferred
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Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)
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Ability to efficiently gather, organize, and comprehend insurance and/ or account information
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Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill
-
Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology
-
Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo
-
Ability to learn quickly and contribute ideas that make the team, processes, and solutions better
-
Share our values: resilience, altruism, communication, achievement, and determination
Preferred Skills:
-
Two or more years of experience working in pre-certification or managed care
Work Location:
This is a remote opportunity but must reside in one of the following states: Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, or Texas.
Position Overview:
As a Pre-certification Specialist, you will be responsible for communicating and maintaining information flow in the managed care referral process for contracted health plans.
Essential Duties & Responsibilities:
-
Oversee the managed care in-patient and outpatient referral and pre-authorization process
-
Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process
-
Maintain referral and authorization records documentation
-
Verify insurance for in-network eligibility and benefits
-
Field calls for prescription benefits questions and prescription verification
-
Contact referring physicians and secure authorizations for treatment
-
Communicate with hospitals to obtain pre-certification numbers
-
Maintain strict confidentiality required related to medical records and other data
-
Participate in professional development opportunities to stay current with health care practices and trends
-
Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office
-
Other duties as assigned
Required Skills:
-
High school diploma or equivalent, college courses, or certificate preferred
-
Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)
-
Ability to efficiently gather, organize, and comprehend insurance and/ or account information
-
Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill
-
Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology
-
Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo
-
Ability to learn quickly and contribute ideas that make the team, processes, and solutions better
-
Share our values: resilience, altruism, communication, achievement, and determination
Preferred Skills:
-
Two or more years of experience working in pre-certification or managed care
Work Location:
This is a remote opportunity but must reside in one of the following states: Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, or Texas.
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