Job Summary We are seeking a detail-oriented and knowledgeable Precertification Specialist to join our team. The Pre-Certification Specialist, under the supervision of the Practice Support Manager is responsible for obtaining authorizations to ensure appropriate reimbursement for services rendered is obtained. The Pre-Certification Specialist works directly with patients, referring physician offices and payers to ensure payer guidelines are met prior to receiving care. Duties Responsible for obtaining in and out of network authorizations for both Physical and Occupational Therapy. Validates patient demographic data, identifies and verifies medical benefits and authorization requirements. Verifies insurance information through payer contacts, online resources or electronic verification systems and identifies payer authorization/ referral requirements. Provides appropriate documentation and follow up to patients and other departments regarding authorization/ referral requirements. Records detailed information related to authorizations/ referrals appropriately. Work collaboratively with insurance carriers to confirm/ verify eligibility and determine out of pocket costs as needed. Research and resolve with insurance payers any issues regarding pre-certifications. Answer calls/ questions regarding pre-cert issues. Additional duties as assigned. Experience Previous experience in a medical or dental office setting is preferred. Familiarity with insurance verification processes is highly desirable. Qualifications Previous pre-certification/ referral experience preferred. Excellent verbal and written skills. Strong organizational skills. Ability to Multi-task. High level of comfort and ability to maneuver web base products. Excellent customer service and telephone etiquette. Understanding of insurance benefit requirements and out of pocket costs. Effective problem-solving skills. Attention to detail. Good decision making. Computer proficiency with Windows, Outlook and Excel. Flexibility in cross training. Understands the importance of maintaining confidentiality per HIPAA guidelines.

Pay:

$16.00 - $19.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Experience:

Precertification:

2 years (Required)

Physical Therapy/Occupational Therapy Authorization :

1 year (Required)

Work Location:

In person