Diagnostic Precertification Specialist - Ortho & Neuro

Carolina Orthopaedic & Neurosurgical Associates; Spartanburg (SC); On-site; USD 41,000 - 54,000; Full time

Job summary

Carolina Orthopaedic & Neurosurgical Associates is seeking a full-time precertification specialist to obtain preauthorizations for diagnostic procedures across orthopedic, neurosurgical, and pain management services.

The role requires attention to detail, strong communication with insurers and staff, proficiency with EMR systems, and a collaborative team attitude in a fast-paced medical office.

Qualifications

• Able to prioritize, work accurately, work well independently and able to maintain focus under pressure.
• Working knowledge of medical terminology, insurance packages/plans and proficient with EMR.
• Clearly communicate with providers, insurance companies and staff.
• Excellent verbal and written communication skills
• Excellent organizational skills, multi-tasking capabilities and detail orientated
• Customer Services skills
• Basic Computer/PC and Internet skills
• Attention to details and problem-solving skills
• Must be a great team player
• High School Diploma (Required)
• 1 year precertification experience (preferred)

Responsibilities

• Contacts insurance companies and other third-party payers to determine preauthorization requirements for diagnostic services.
• Calls insurance companies or uses online tools to obtain preauthorization. Follows up timely and thoroughly.
• Ensures all preauthorization issues are communicated in a timely manner.
• Liaisons with the physician’s staff to obtain additional insurance and/or clinical information.
• Reviews patients' charts and submits appropriate and pertinent information from the clinicals for medical necessity for the service.
• Follows up properly on all denials and peer-to-peer requests.
• Documents appropriately regarding all actions, authorization, and denials.

Skills

Verbal communication

Written communication

Medical terminology

EMR proficiency

Insurance knowledge

Attention to detail

Team player

Customer service

Organization

Education

High School Diploma

Job description

Carolina Orthopaedic & Neurosurgical Associates is seeking a full-time precertification specialist to obtain preauthorizations for diagnostic procedures across orthopedic, neurosurgical, and pain management services.

The role requires attention to detail, strong communication with insurers and staff, proficiency with EMR systems, and a collaborative team attitude in a fast-paced medical office.