Pre Certification Collection Specialist

OrthoCarolina; Town of Charlotte (NY); Hybrid; USD 30,000 - 47,000; Full time

Job summary

OrthoCarolina in Charlotte is seeking a Pre-Certification Collections Specialist to join our Utilization Review team in the Business Office. The role serves as a liaison among patients, insurers, physicians and facilities, focusing on eligibility, benefits and precertification.

This hybrid position combines high-volume calls with account tracking, pre-collection of patient balances, and authorization activity.

Qualifications

• Knowledge of physician, facility and hospital pre-certification.

Responsibilities

• Confirm eligibility, benefits and precertification with insurance carriers for patients scheduled with physician and facility.
• Pre-collect from patients including unpaid, true patient current balance, and estimated financial responsibility.
• Track the account from notification of scheduled appointment including same-day and next-day add-ons for authorization.
• Identify and correct internal problems within accounts to expedite payments from insurers.
• Use online tools for benefits review, prior plan approval requirements, initiating and obtaining authorizations.

Skills

Accounts Receivable

Customer Service

Data Entry

Documentations

Office Management

Patient Account Management

Patient Care

Payment Analysis

Job description

AtOrthoCarolina, 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.OrthoCarolinahas 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 foraPre-Certification Collection SpecialisttojoinourUtilization ReviewteamintheOrthoCarolinaBusiness Office in Charlotte.

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

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

Essential Functions:

• Confirming eligibility,benefitsand 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 estimatedfinancial responsibilityup to and including entire Out of Pocket when necessary.

• Responsiblefor trackingthe account from notification of scheduled appointment including same day and next day add-ons for authorization as well as pre-collection of patientfinancial responsibility.

• Responsibleforidentifyingandcorrectinginternal problems within assigned accounts toexpeditepayments from insurance companies.

• Responsible for using online tools for benefits, reviewing medical criteria/policy, prior plan approval (PPA) requirements,initiatingand obtaining authorizations

Skills and Abilities:

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

Employee Type

Regular

Qualifications

Skills

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

Education

Certifications

Language

Work Experience