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.
- 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