Position title
Insurance Pre-Certification Coordinator
Description

POSITION SUMMARY:

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. 

ESSENTIAL POSITION FUNCTIONS: 

  • Receives the necessary insurance and surgery scheduling information from the surgery coordinators for patients scheduled for surgery. Includes information from all insurance plans except Coventry and CMO’s.
  • Places a call to the insurance company customer service office to pre-certify CPT codes along with an ICD9 code requested by the physician for surgical procedures.
  • Checks insurance eligibility and benefits on patients scheduled for surgery.
  • Informs the surgery coordinator if there is a change in insurance coverage or benefits and obtains new information from the insured so that it can be entered into our system.
  • Opens a case number for insurances requiring a pre-cert, or patient eligibility and benefits are verified for. This will allow the reimbursement department to bill the surgery codes.
  • Precertifies all diagnostic tests such as MRI’s CT scans, Sleep Studies, pH Probes, Airway Fluoroscopies, etc.

SUPERVISORY DUTIES:

  • None

POSITION REQUIREMENTS:

  • High school education or G.E.D. equivalent
  • At least one year of experience in a surgical medical practice is preferred
  • Working knowledge of CPT and ICD9 coding
  • Possesses the knowledge and experience to understand insurance terms and requirements for precertification
  • Understands medical terminology, types of diagnostic tests, and surgical procedures
  • Strong oral and written communication skills

WORKING ENVIRONMENT:

  1. Physical Demands:

Lifting Requirements:                    0-20 lbs.

Frequency of Lifting                        0-15% of the time

The average percent of the time during a regular shift devoted to:

Walking, Squatting, Sitting, Bending, Reaching:        90%

Standing:                                                                              10%

  1. Visual, Hearing, Dexterity, and Mental Demands:

Vision:  Adequate to perform the essential functions of the job such as read a computer terminal for long periods.  Correctable to 20/20

Hearing:  Adequate to perform the essential functions of the job such as answering the telephone

Speaking:  Adequate to perform the essential functions of the job such as communicating via telephone

Dexterity:  Adequate to perform the essential functions of the job such as sorting papers, stapling, operating a computer keyboard and other office equipment.

Mental Demands:  Adequate to perform the essential functions of the job such as communication with insurance plan representatives, reimbursement staff and parents. Must be able to handle a fair amount of stress.

Employment Type
Full-time
Job Location
Date posted
July 30, 2021
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Position: Insurance Pre-Certification Coordinator

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