Job Title: Insurance Pre-Certification Specialist Department: Clinical
Reports To: Administrative Services Manager Effective Date: January 1, 2023
Job Summary:
Under general supervision, the Pre-Certification Specialist is responsible for assuring the timely and accurate pre-certification of assigned procedures to ensure proper payment is secured by the physician and organization. This position will also have a critical role in the scheduling of procedures, diagnostic studies and new patient referrals. As a member of the clinical team, this position will also have other clinical duties to ensure the best possible care for our patients.
Responsibilities & Duties:
- Securing the most up-to-date patient demographic and insurance information
- Safe, accurate and timely scheduling of procedures, diagnostic studies and/or new patient referrals
- Effectively communicating with referring sources, patients, the surgery center and physicians
- Precertification of procedures and/or diagnostic studies
- Timely handling of voice messages for the scheduling department
- Other responsibilities assigned by supervisor or operations manager
Clinic Team Member Responsibilities:
- Communicate effectively with patients/families and the clinic team in a manner that promotes positive working relationships.
- Understand own behavior and how it affects others.
- Within defined standards and with minimal supervision, problem solves and makes decisions about clinic functions and patient care issues as an active team member.
- Occasionally provide organizational and clerical support to facilitate optimal patient care and clinic operation.
- Demonstrate proficiency in use of the computer for appointment scheduling, visit processing, order entry, charge entry, documentation of patient care and retrieval of information.
- Participate in orientation of selected employees.
- Complete required annual in-service and training programs.
Requirements/Preferences:
- A thorough understanding of insurance pre-certification process required
- Knowledge of medical terminology, abbreviations, techniques and surgical procedures required
- High School Diploma or equivalent required
- Clinical Education or Training Required
- Prior clinical experience required
- Prior Experience in Orthopaedic care preferred
- Must possess basic computer skills (email, messaging, etc.)
Physical Requirements:
- Ability to occasionally lift up to 25 pounds maximum.
- Must be able to sit for extended periods of time.
- The person in this position needs to occasionally move about inside the office to access equipment, supplies, etc.
- The ability to communicate information and ideas so others will understand.
- Must be able to exchange accurate information to patients, physicians and co-workers.
Miscellaneous Requirements:
- Above average communication skills
- Above average interpersonal relationship skills
- Must have strong customer service
- Must have strong attention for detail
- Must be proficient using computer programs