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
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Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process
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Maintain referral and authorization records documentation
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Verify insurance for in-network eligibility and benefits
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Field calls for prescription benefits questions and prescription verification
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Contact referring physicians and secure authorizations for treatment
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Communicate with hospitals to obtain pre-certification numbers
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Maintain strict confidentiality required related to medical records and other data
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Participate in professional development opportunities to stay current with health care practices and trends
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Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office
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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
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Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology
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Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo
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Ability to learn quickly and contribute ideas that make the team, processes, and solutions better
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Share our values: resilience, altruism, communication, achievement, and determination
Preferred Skills:
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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.