Pre Certification Collection Specialist

OrthoCarolina; Charlotte (NC); Hybrid; USD 42,000 - 62,000; Full time

Job summary

OrthoCarolina in Charlotte, NC is seeking a Pre-Certification Collections Specialist to join the Utilization Review team. This regular, full-time position offers a hybrid schedule with rotating in-office days depending on department needs.

The role focuses on coordinating between patients, insurers, physicians, and facilities to verify eligibility and collect the patient financial responsibility. Strong knowledge of pre-certification processes is required.

Qualifications

• Must have knowledge of physician, facility and hospital pre-certification.
• Experience in accounts receivable or patient financial responsibilities is helpful.
• Ability to navigate insurance processes and patient communications.

Responsibilities

• Confirming eligibility, benefits and precertification with insurance carriers for patients scheduled with physician and facility.
• Pre-collect from patients including unpaid balances and estimated financial responsibility.
• Track accounts from notification of scheduled appointments including same day/next day add-ons for authorization and pre-collection.
• Identify and correct internal problems within accounts to expedite payments from insurance companies.
• Use online tools for benefits, policy review, prior authorization requirements, initiating and obtaining authorizations.

Skills

Pre-certification knowledge

Job description

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit https://www.orthocarolina.com/about-us

We are currently searching for a Pre-Certification Collection Specialist to join our Utilization Review team in the OrthoCarolina Business Office in Charlotte.

This position is a hybrid schedule with rotating days in the office depending on department needs.

Essential Functions

The Pre-Certification Collections Specialist serves as liaison between the patient, insurance company, physician, and facility. There is a large volume calling patients and insurance companies. Other duties include:

• Confirming eligibility, benefits and precertification with insurance carriers for patient's scheduled with Physician and facility.
• Responsible to pre-collect from patients including unpaid, true patient current balance, patient's estimated financial responsibility up to and including entire Out of Pocket when necessary.
• Responsible for tracking the account from notification of scheduled appointment including same day and next day add-ons for authorization as well as pre-collection of patient financial responsibility.
• Responsible for identifying and correcting internal problems within assigned accounts to expedite payments from insurance companies.
• Responsible for using online tools for benefits, reviewing medical criteria/policy, prior plan approval (PPA) requirements, initiating and obtaining authorizations

Skills And Abilities

• Must have knowledge of physician, facility and hospital pre-certification.

Employee Type

Regular

Qualifications

Accounts Receivable (AR), Customer Service, Data Entry, Documentations, Office Management, Patient Account Management, Patient Care, Payment Analysis