Epidural Pre-Certification Representative

Rothman Orthopaedics; Philadelphia (Philadelphia County); On-site; USD 26,000 - 32,000; Full time

Job summary

The Pre-Certification Representative at Rothman Orthopaedics in Center City, Philadelphia ensures accurate, efficient processing and communication with insurance companies for pre-certification and authorization of procedures. You will review requests, verify benefits and schedules, document all details in patient records, and coordinate with Financial Counseling to address high out-of-pocket costs.

This role starts in-office with training, then remote eligibility is available after training,

Qualifications

• High School diploma or GED minimum education requirement.
• Medical office operations and medical terminology knowledge required.
• One year of pre-certification experience highly preferred.
• Computer skills including, but not limited to, MS Office Suite

Responsibilities

• Processes all incoming requests for pre-certification and authorization for upcoming procedures being performed by a physician or department at Rothman Institute.
• Reviews physician schedules prior to scheduled procedures to ensure all have been pre-certified or authorized.
• Reviews benefits to ensure patient has adequate coverage and communicates high out-of-pocket expenses to the Financial Counseling team.
• Notates patient's account with all information relevant to the authorization and pre-certification process, including filling out Structured Data fields in eCW referral.
• Faxes/uploads required pre-certification paperwork to insurance company, adjuster or medical review department to ensure authorization is obtained.
• Responsible for pre-certification process in its entirety, including communicating denials and initiating appeals.
• Manages all workers' compensation and auto pre-certifications due to additional time required by these payers to obtain approval.

Skills

Medical terminology

Pre-certification basics

Medical office operations

Education

High School diploma or GED

Tools

MS Office Suite

Job description

Job Details

Job DetailsLevel: ExperiencedJob Location: Center City 833 Chestnut - Philadelphia, PA 19107Position Type: Full TimeEducation Level: High SchoolTravel Percentage: NoneJob Shift: Day ShiftJob Summary:

The Pre-Certification Representative ensures accurate, efficient processing and interaction with all insurance companies and staff with regard to pre-certification.

Key Accountabilities

• Daily report of completed vs pending pre-certs, monthly total of pre-certs by FTE, number of cancellations by physician/FTE.

Job Duties

• Processes all incoming requests for pre-certification and authorization for upcoming procedures being performed by a physician or department at Rothman Institute. Reviews all requests for appropriate information required to get approval and accurate benefit information.
• Reviews physician schedules prior to scheduled procedures to ensure all have been pre-certified or authorized.
• Reviews benefits to ensure patient has adequate coverage and communicates high out-of-pocket expenses to the Financial Counseling team.
• Notates patient's account with all information relevant to the authoirzation and pre-certification process, including filling out Structured Data fields in eCW referral.
• Faxes/uploads required pre-certification paperwork to insurance company, adjuster or medical review department to ensure authorization is obtained.
• Responsible for pre-certification process in its entirety, including communicating denials and initiating appeals.
• Manages all workers' compensation and auto pre-certifications due to additional time required by these payers to obtain approval.

Job Qualifications

• High School diploma or GED minimum education requirement
• Medical office operations and medical terminology knowledge required
• One year of pre-certification experience highly preferred
• Computer skills including, but not limited to, MS Office Suite

Location

• remote after training
• training in office at 833 Chestnut St, Philadelphia, PA

Hours

Monday - Friday: 8:00am - 4:30pm

Pay Range

$19.00/hr - $23.00/hr

Our Commitment to Employees

Come work at Rothman Orthopaedics! Our employees are our single greatest asset, as such, we strive to provide a professional, nurturing environment where every member of our team can make a meaningful difference in the lives of others. This commitment to our employees has earned us the distinction as a Top Workplace in Philadelphia by the Philadelphia Inquirer year after year. Our employees enjoy competitive pay, comprehensive health and dental benefits, tuition reimbursement, paid time off, and retirement savings plans.

Rothman Orthopaedics is an Equal Opportunity employer committed to providing opportunities to all qualified applicants without regards to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. We value developing an inclusive and equitable environment that strengthens our organization and allows us to better attract and retain a diverse workforce that is representative of our patients and our community. We model our values by creating and enacting practices that encourage participation from all backgrounds, perspectives, and experiences.

Remote Employment Policy

If you are being hired into a remote eligible position, please be aware that Rothman Orthopaedics is only registered to support remote employment in a limited number of states. If you relocate to a new state and Rothman Orthopaedics is not registered in that state, you may no longer be eligible for a remote position and continued employment with Rothman Orthopaedics. Please contact HR for any questions or a list of states where remote employment may be authorized.