Precertification Specialist - Full Time at Optalis

Lima, Ohio, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Aug, 26

Salary

0.0

Posted On

11 May, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Verification, Prior Authorization, Medical Billing, CPT Coding, ICD-10 Coding, EMR Systems, Patient Confidentiality, Insurance Appeals, Medical Policy Guidelines, Communication Skills

Industry

Description

Summary: The Precert Specialist verifies insurance coverage and benefits for a wide range of testing, procedures, evaluations, treatments, etc. ordered for the patient. General Summary of Duties: (Other duties may be assigned.) * Contact insurance company to verify patient coverage and obtain information concerning extent of benefits * Completes forms as required by insurance to permit treatment by provider * Review chart documentation to ensure patient meets medical policy guidelines * Prioritize incoming authorization requests according to urgency * Obtain authorization via payer website or by phone and follow up regularly on pending cases * Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations * Initiate appeals for denied authorizations * Respond to clinic questions regarding payer medical policy guidelines * Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order * Properly utilize EMR system and remain up to date on required training and procedures related to EMR system * Secure patient information and maintain patient confidentiality * Assist in coverage of other staff when necessary; Participate in orientation of employees when needed * Communicate efficiently with other departments to ensure best care for patient Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required Education and Training: * High School diploma or equivalent required at minimum * Experience working in related position preferred Physical Demands and Working Conditions/Requirements: * Requires prolonged periods of sitting at desk, working at computer, and being on the phone * Must have good computer and telephone communication skills and able to operate misc. office equipment * Hearing and vision abilities within normal range, or corrected, to observe and communicate with patients and staff * Ability to work in fast-paced environment in a professional medical office setting * Reasonable accommodations may be made to enable individuals with disabilities to perform the necessary functions Position Type and Expected Hours of Work: Full time: 40 hours minimum per week; available for overtime as needed; varied day shift hours on week days Travel Requirements: No travel anticipated Full-time Benefits * Health, Dental, and Vision Insurance * 401k Plan, 3% Safe Harbor Non-Elective Employer Contribution * Employer-provided $25,000 Group Life Insurance * Voluntary Life Insurance * Short-Term and Long-Term Disability * Accident, Hospital, Critical Illness/Cancer Benefits * Mileage Reimbursement for travel between office locations * Certificate and Continuing Education Reimbursement * Accrual Paid Time Off (up to 19 days off within 1st year) * 6 Paid Holidays Per Year * Closed on Major Holidays

Responsibilities

The specialist verifies insurance coverage and obtains necessary authorizations for patient procedures and treatments. They are responsible for reviewing medical documentation, managing payer files, and initiating appeals for denied authorizations.