Precertification Specialist
- Indiana Spine Group, P.C.
- Carmel, IN Indiana Spine Group
- 2.
6 Carmel, IN Job Details Full-time 10 hours ago Benefits Disability insurance Health insurance Dental insurance 401(k) Paid time off Employee assistance program Vision insurance 401(k) matching Life insurance Qualifications Teamwork Customer service Medical coding HIPAA High school diploma or GED Insurance medical billing Attention to detail Health information regulatory compliance Organizational skills Task assignment Time management Full Job Description Who Are We? Looking for a position with supportive co-workers who value the patient and an organization that values your contributions? Indiana Spine Group is a growing physician specialty practice with multiple central Indiana locations. We are committed to providing excellent care for our patients and in turn understand the importance of providing the same to our employees. Teamwork is emphasized as well as each employee's responsibility for individual workload.
ROLE OVERVIEW
: Pre-Certification Specialist oversees the process of obtaining prior authorizations. This process includes collecting all necessary documentation, and contacting facilities, physician and/or staff for additional information. It also involves communication with a member or patient. Ability to quickly determine whether the order will likely be approved based on documentation and submitting the request via online portal or over the phone to insurance. This position may also be responsible for obtaining cost estimates, for the necessary approvals to be made as well as collecting pre-payments from patients. Able to work in an environment that may be stressful at times with ability to meet firm deadlines.
QUALIFICATIONS
High School graduate or GED equivalent Minimum of 3 years of experience in Medical or Insurance field Medical billing/coding knowledge required Understanding of CPT and DX codes, specifically related to the Spine (preferred) Prior Pre-Certification experience preferred
ESSENTIAL DUTIES
The following list describes the essential duties of this role. Individuals in this role may not perform all of these duties, or may perform additional or unrelated duties Verify patient eligibility and review benefits Verify all codes are reviewable benefits Review codes and submit prior authorization request Review and submit clinicals documentations Follow through with obtaining the prior authorization Coordinate Peer-to-Peer review when needed Submit Appeals Collect pre-payments when applicable Submit retro-authorizations when applicable Meets department production standards consistently as defined by the department management Perform all duties respectful of confidentiality and safety of all patients, employees, and providers Requires working knowledge of HIPAA Privacy Rules compliance
MINIMUM QUALIFICATIONS
: Excellent verbal and written communication skills Excellent interpersonal and customer service skills Excellent organizational skills and attention to detail Excellent time management skills with a proven ability to meet deadlines Strong analytical and problem-solving skills Ability to prioritize tasks and to delegate them when appropriate Ability to function well in a high-paced and at times stressful environment Gets along well with others and can work with peers in a team situation
Benefits:
401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance Application Question(s): Prior Pre-Certification experience is preferred. Medical billing/coding knowledge is required. Understanding of CPT and DX codes, specifically related to the Spine is preferred.
Experience:
Medical or insurance field: 3 years (Required)
Work Location:
In person
