Pre-Certification Specialist

Alliance Spine and Pain Centers; Atlanta (GA); On-site; USD 38,000 - 54,000; Full time

Job summary

Alliance Spine and Pain Centers is seeking a Full-Time Pre-Certification Specialist at the Buckhead location. This role supports insurance verification, referrals, and pre-certifications for surgeries and procedures, while educating patients on costs and coverage.

You will maintain accurate records in the practice management system and liaise with staff to ensure timely authorizations. Qualified candidates have a high school diploma, strong organization, medical terminology knowledge, and

Qualifications

• High school diploma or equivalent.
• Organization and attention to detail.
• Working knowledge of medical terminology.
• ICD-10 and CPT codes.
• Pre-certification and authorization experience in specialist office and radiology.
• Insurance verification experience (strongly preferred).

Responsibilities

• Verifies insurance benefits and obtains referrals and pre-certifications for procedures.
• Updates patient accounts in the practice management system.
• Generates Letters of Medical Necessity as requested by Insurance Carriers.
• Maintains knowledge of billing policies and procedures.
• Responds to staff or patient questions regarding insurance procedures and policies.
• Serves as patient advocate during the account cycle and notes benefits in the system.
• Attends insurance-related meetings as needed.
• Ensures compliance with applicable regulations and internal policies.

Skills

Organization and attention to detail

Medical terminology knowledge

Customer service

Communication skills

Education

High school diploma or equivalent

ICD-10 and CPT codes

Pre-certification and authorization experience in specialist office and radiology

Insurance verification experience (strongly preferred)

Tools

Eclinical

Microsoft Office

Job description

Alliance Spine and Pain Centers is looking for a Full-Time Pre-Certification Specialist for our Buckhead location. This is a Monday-Friday position with a full benefits package.

Job Summary

Under general supervision verifies insurance, obtains referrals and pre-certs for surgeries and other procedures. Educates patients regarding the cost of treatment, insurance coverage and the patient’s responsibility for ensuring payment for all financial obligations to Alliance Spine & Pain Centers (ASPC).

Essential Duties and Responsibilities

• Identifies and obtains a referral authorization when appropriate. Verifies appropriate network for claims processing. Verifies and updates insurance benefits and referral information for existing patients and ensures current pre-certifications are obtained for procedures. Obtains a new referral when necessary.
• Updates patient accounts in practice management system.
• Generate Letters of Medical Necessity as requested by Insurance Carriers.
• Maintain an in depth awareness of billing policies and procedures.
• Responds to staff or patient’s questions regarding insurance procedures and policies.
• Serves as patient advocate during the cycle of the patient’s account as needed.
• Notes information regarding patients’ benefits in the practice management system.
• Attends insurance related meetings on and/or off-site.
• Completes work within authorized time to assure compliance with departmental productivity.
• Maintains clean and orderly workspace and organized files.
• Clearly communicates thoughts verbally and in written form.
• Maintains positive working relationship with patient concierges, Revenue Cycle managers and directors, and Regional Administrators.
• Demonstrates knowledge of, and supports, ASPC/ IMS’ mission, vision, standards, policies and procedures, operating instructions, confidentiality standards, and the Code of Ethical Behavior.
• Performs other assigned duties and special projects.
• Ensures compliance with JCAHO.
• Complies with all applicable HIPPA rules and regulations.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

• High school diploma or equivalent
• Organization and attention to detail
• Working knowledge of medical terminology
• ICD-10 and CPT codes
• Pre-certification and authorization experience in specialist office and radiology
• Insurance verification experience ( strongly preferred)

Communication Skills:

Strong customer service skills. Ability to maintain good relationships with insurance representatives. Ability to effectively give and receive information from insurance carries, providers and ISPM employees.

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills:

Working knowledge of Eclinical. Basic knowledge of Microsoft Office.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to walk and use hands to finger, handle, or feel. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 100 pounds. Specific vision abilities required by this job include close vision and distance vision.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is occasionally exposed to work near moving mechanical parts; fumes or airborne particles and toxic or caustic chemicals. The noise level in the work environment is usually moderate.