Pre-Certification Specialist

Bone & Joint; Town of Wausau (WI); On-site; USD 25,000 - 33,000; Full time

Job summary

Bone & Joint is seeking a Pre-Certification Specialist to join a fast-paced office in Wisconsin. You will manage online and phone-based prior authorizations and verify patient benefits to ensure coverage aligns with clinic needs.

You will work with providers, ambulatory surgery center teams, and the billing group to streamline authorization processes and support timely patient care. Strong attention to detail and people skills are essential.

Qualifications

• High school diploma or equivalent required.
• Patience and ability to work with people at all levels, internal and external, required.
• Must have great attention to detail.
• 1+ years' experience with online and telephone prior authorizations for services.
• Experience and knowledge of all types of insurances (government, commercial, programs, private).

Responsibilities

• Process insurance prior authorizations via online or phone.
• Verify benefits and active coverage for patients.
• Collaborate with Providers, clinical teams, Registration, coding & billing, and outside carriers.

Skills

Interpersonal skills

Attention to detail

Prior authorizations

Insurance knowledge

Education

High school diploma or equivalent

Job description

We are looking to add someone to our team who can work in a fast-paced environment with great customer service, has great attention to detail, and can quickly adapt to change throughout the day. If you have medical insurance and prior authorization experience who promotes positivity, this position is for you.

ABOUT BONE & JOINT

Bone and Joint has one of the most comprehensive teams of orthopedic, pain management, podiatric, physical and occupational therapy experts in Northcentral Wisconsin. We aren't a division of another corporate healthcare organization; Bone & Joint belongs to us and we have numerous locations throughout Central Wisconsin. Our mission is to be the Best place for patients to receive care, the Best place for employees to work, and the Best place for physicians to practice medicine.

A DAY IN THE LIFE OF A PRE-CERTIFICATION SPECIALIST

Being a part of the Pre-Certification/Verification of Benefits Team you will complete a variety of tasks each day in a very fast-paced environment. Our Pre-Certification Specialists work with several different departments throughout Bone & Joint. You will work and communicate daily with our Providers, their clinical teams, Ambulatory Surgery Center teams, Registration, coding & billing team, Therapy teams along with outside companies such as Insurance carriers, and other outside hospital systems. Primarily you will be completing insurance prior authorizations via online or over the phone for procedures, surgery, High end imaging, DME, etc. that our ordered by our providers. We also complete verification of benefits for all patients to ensure they have active coverage and a plan that Bone & Joint accepts at our clinics and Walk-in locations.

QUALIFICATIONS FOR A PRE-CERTIFICATION SPECIALIST

• High school diploma or equivalent
• Patience and ability to work with people at all levels, internal and external, required.
• Must have great attention to detail.
• 1 plus years' experience with online and telephone prior authorizations for services.
• Experience and knowledge of all types of insurances (government, commercial, programs, private).

WORK SCHEDULE

Workdays of a Pre-Certification Specialist are Monday through Friday 8:30AM to 5:00PM with a 30-minute lunch. Additional flexibility may be offered after the training period and based on business needs.