Orthopaedic Associates is a fast-paced, 14-physician orthopaedic practice with four practice locations in Evansville and Newburgh, IN and Henderson, KY. We are currently seeking a Precertification Liaison to join our team. This would be a full-time position and would be benefits eligible. We are closed on the six major holidays and new employees are eligible for holiday pay and insurance after completing their first 60 days of employment. We also offer a lucrative PTO plan and 401k with a matching component. Hours are generally Monday - Friday, 8am - 4:30pm.
A Precertification/Preauthorization Liaison obtains preapproval from the insurance company for medical procedures, imaging, treatments, DME or other services on behalf of the provider. Responsibilities may include verifying patient insurance coverage, gathering necessary medical information, submitting precertification requests and ensuring compliance with internal policies. Additionally, the Liaison may communicate with providers and insurance representatives to resolve any issues or discrepancies that arise during the precertification process. Strong communication skills, attention to detail and knowledge of medical terminology and insurance regulations are typically required for this role.
- Verify insurance eligibility/insurance coverage and precertify/preauthorize medical procedures, imaging, treatments, DME or other services
- Assist patients and co-workers with questions related to insurance authorizations
- Ensure all policies governing commercial pre-certification and authorization are followed
- Speaking with and/or calling patients when needed
- Serve as a primary resource to providers, staff, patients and scheduling facilities for all inpatient/outpatient surgical procedure, imaging and injection prior authorization requirements
- Collect clinical and coding information regarding services to be rendered
- Advise providers and staff when issues arise relating to obtaining prior authorization
- Stay informed and research information regarding insurance criteria for prior authorization
- Report potential documentation improvement opportunities to the Precertification/Preauthorization Team Leader
- Maintain patient confidentiality in compliance with company policies and procedures
QUALIFICATIONS,EDUCATION AND/OR EXPERIENCE
High school diploma or GED certificate required
- Understanding of and experience with insurance billing
- Proficiency with computer software applications including Excel and Word.
- Ability to multitask and work in a fast paced environment
- Pleasant and cheerful attitude and willingness to assist patients
- Must have excellent work habits, including a willingness to work the necessary hours to get the job done
