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Medical - Pre-Cert Department
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Spine and Orthopedic Center of New Jersey
Sparta, NJ (In Person)
$40,560 Salary, Full-Time
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Job Description
Job Overview Join our dynamic Pre-Cert Department as a vital team member dedicated to streamlining the approval process for medical services and procedures. In this role, you will be the first line of contact for verifying insurance coverage, ensuring compliance with health insurance policies, and facilitating timely pre-certification for patients' medical needs. Your energetic approach and attention to detail will help improve patient care coordination while maintaining strict adherence to confidentiality and healthcare regulations. This position offers an exciting opportunity to work within a fast-paced healthcare environment, supporting both clinical teams and insurance providers to deliver seamless service. Duties Review and verify patient insurance information, including health insurance policies and managed care plans, ensuring eligibility and coverage for upcoming procedures. Obtain necessary pre-certification approvals from insurance companies by submitting detailed documentation, including medical records and clinical notes. Utilize Electronic Medical Records (EMR) or Electronic Health Records (EHR) systems to accurately document all pre-certification activities and correspondence. Apply medical coding knowledge, including CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems, to support accurate billing and authorization processes. Communicate effectively with healthcare providers, insurance representatives, and patients to clarify requirements, resolve issues, and expedite approvals. Maintain strict compliance with HIPAA regulations and clinical confidentiality policies when handling sensitive medical records and patient information. Stay updated on health insurance policy changes, medical terminology, and industry best practices to ensure accurate processing of all requests. Skills Proven experience working in a medical office environment with familiarity in medical records management and office procedures. Expertise in CPT coding, ICD-9/ICD-10 coding systems, and overall ICD coding processes for accurate documentation. Knowledge of managed care plans, health insurance policies, and insurance verification procedures. Proficiency with EMR/EHR software platforms for efficient record keeping and communication. Excellent organizational skills with the ability to prioritize tasks in a fast-paced setting while maintaining attention to detail. Familiarity with dental office experience is a plus, as well as general office experience in healthcare environments. Join us in making a difference by ensuring that patients receive the care they need without delay! Your proactive attitude combined with your healthcare expertise will contribute significantly to our mission of delivering exceptional service through efficient pre-certification processes.