Billing Specialist

POSITION: Pre-Cert and Pre-Determination Specialists

DEPARTMENT: Business Office

REPORTS TO: Business Office Supervisor

JOB SUMMARY: This individual is responsible for all procedure Pre-Cert and Pre-Determination.

EDUCATION AND EXPERIENCE:

• High School diploma or equivalent.
• Two years minimum experience in medical office; billing and collections experience perferred.

ESSENTIAL SKILLS AND ABILITIES:

• Excellent communication skills, written and oral.
• Strong organization skills with attention to detail.
• Excellent follow-up skills.
• Management of multiple tasks simultaneously.
• Work as a team player by demonstrating ability to work well and get along with co-workers.

RESPONSIBILITIES:

• Responsible for all calls to insurances for pre-cert on in-office procedures.
• Responsible for all calls to insurances for out-patient surgery for pre-determinations.
• Responsible for all faxes and mailings to insurance for pertinent information for medical necessity.
• Must call insurances to inquire on eligibility for surgery.
• Contact key personnel on denials. Make sure surgery scheduler informs physician of denial.
• Responsible for all Botox orders on patients that have to have an authorization.
• Speaks with patients in regards to their questions they may have on their pre-cert or pre-determination.

Other Duties assigned, but not limited too:

• Checks the mail when the Payment Poster is not available.
• Help send out statements
• Pull files for A/R or RX line