Job Summary
We are seeking a proactive and detail-oriented Precertification Specialist to join our Plastic Surgery office. In this role, you will be responsible for managing the precertification and prior authorization processes for major and minor surgical procedures, ensuring timely approval from insurance providers, and scheduling procedures. Your expertise will help streamline patient care, reduce delays, and ensure compliance with healthcare regulations. This position offers an exciting opportunity to contribute to improved patient outcomes through efficient insurance verification and authorization workflows.
Responsibilities
- Review medical records, clinical documentation, and patient information to determine precertification requirements for procedures and treatments.
- Communicate with insurance companies to obtain prior authorization or precertification approvals, following up as needed to ensure timely responses.
- Verify insurance coverage and benefits for patients, to facilitate smooth authorization processes.
- Maintain accurate and detailed documentation of all authorization requests, approvals, denials, and related correspondence in medical records systems.
- Collaborate with physicians and mid-level providers, medical offices, and patient to gather necessary information for authorization submissions.
- Communicate with patients to coordinate procedure and collect payment.
- Ensure compliance with HIPAA regulations by safeguarding patient information during all stages of the authorization process.
- Stay current on changes in insurance policies, CPT coding (Current Procedural Terminology), ICD coding (International Classification of Diseases), including ICD-9 and ICD-10 updates, and healthcare regulations affecting precertification procedures.
Qualifications
- Proven experience in medical office settings with a focus on insurance verification and precertification processes for major and minor surgery.
- Strong understanding of medical terminology, medical records management, and medical coding practices including CPT, ICD-9, ICD-10, and ICD coding systems.
- Familiarity with insurance portal navigation.
- Ability to clearly communicate insurance plan details to patients and review financial obligations prior to scheduled procedures.
- Excellent communication skills for effective interaction with insurance carriers, healthcare providers, and patients.
- Office experience with proficiency in electronic health records (EHR) systems or other medical office software.
- Ability to multitask efficiently in a fast-paced environment while maintaining attention to detail.
Join us in making a difference by ensuring that patients receive the care they need without unnecessary delays! This role is perfect for motivated individuals eager to support exceptional patient service through effective insurance management.
Pay: $20.00 - $23.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee discount
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
