Orthopedics Pre-Certification & Scheduling Specialist

Charleston Area Medical Center; Charleston (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

Charleston Area Medical Center in Charleston, WV seeks a Pre-Certification Specialist for Orthopedics Northgate to ensure accurate pre-certification authorizations and referrals, and to manage patient charts.

You will schedule tests, exams, and surgeries, communicate with insurers, and maintain up-to-date medical terminology and coding standards (ICD-10, CPT, HCPCS). Must be detail-oriented and capable of cross-training across front desk and MA roles.

Qualifications

• Daily review of charts to determine pre-certification needs and referrals.
• Review patient insurance info to determine medical necessity requirements.
• Prepare correspondence with insurers and physicians regarding authorizations.
• Schedule procedures and coordinate information across teams.

Responsibilities

• Daily review of charts to determine if pre-certification/pre-authorization or referrals are needed.
• Review specific patient insurance info to determine medical necessity requirements for specific treatments.
• Correspond with Medicare and various insurance companies to obtain data on authorizations and verifications.
• Perform clerical duties including letters to patients, insurers and referring physicians.
• Schedule patient surgery and communicate information to parties per physician order.
• Make referrals based on test results and physician review.

Skills

Attention to detail

Customer service

Multitasking

Communication skills

Education

High School Diploma or GED

Tools

Billing software

Job description

Charleston Area Medical Center in Charleston, WV seeks a Pre-Certification Specialist for Orthopedics Northgate to ensure accurate pre-certification authorizations and referrals, and to manage patient charts.

You will schedule tests, exams, and surgeries, communicate with insurers, and maintain up-to-date medical terminology and coding standards (ICD-10, CPT, HCPCS). Must be detail-oriented and capable of cross-training across front desk and MA roles.