Columbia Orthopaedic Group

Job Summary:

A Precertification Specialist is responsible for obtaining authorizations for all procedural orders with all insurance payers, as well as checking benefits and collecting payments for upcoming appointments.

Duties/Responsibilities:

• Review chart documentation to ensure patients meet medical policy guidelines.
• Prioritize incoming authorization requests according to urgency.
• Obtain authorization via payer website or by phone, and follow up regularly on pending cases.
• Maintain individual payer files, including up-to-date requirements needed to successfully obtain authorizations.
• Respond to clinic questions regarding payer medical policy guidelines.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
• Contact patients to discuss authorization status, benefits, and payment expectations for upcoming appointments.
• Assist in verifying insurance benefits, including deductible and copayment amounts, to inform patients of their financial responsibilities.
• Collect payment information and facilitate payment arrangements as needed prior to scheduled procedures.

Required Skills/Abilities:

• Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle.
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
• Basic understanding of human anatomy, specifically musculoskeletal.
• Proficient use of CPT and ICD-10 codes.
• Excellent computer skills including Excel, Word, and Internet use.
• Detail-oriented with above-average organizational skills; plans and prioritizes to meet deadlines.
• Excellent customer service skills; communicates clearly and effectively, especially regarding financial discussions with patients.
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
• Work well within a team environment and be able to work flexible hours as needed.

Education:

• High School Diploma or GED (required).

Work Experience:

• 2 years of medical authorization experience, preferred.
• 2 years of experience in a medical-related field, preferred.

Physical Requirements:

• Prolonged periods of sitting at a desk, working on a computer, and answering phones.