Pre-Certification Specialist: Medical Auth & Insurance

Rothman Orthopaedics; Philadelphia (Philadelphia County); Hybrid; USD 26,000 - 32,000; Full time

Job summary

The Pre-Certification Representative at Rothman Orthopaedics in Center City, Philadelphia ensures accurate, efficient processing and communication with insurance companies for pre-certification and authorization of procedures. You will review requests, verify benefits and schedules, document all details in patient records, and coordinate with Financial Counseling to address high out-of-pocket costs.

This role starts in-office with training, then remote eligibility is available after training,

Qualifications

• High School diploma or GED minimum education requirement.
• Medical office operations and medical terminology knowledge required.
• One year of pre-certification experience highly preferred.
• Computer skills including, but not limited to, MS Office Suite

Responsibilities

• Processes all incoming requests for pre-certification and authorization for upcoming procedures being performed by a physician or department at Rothman Institute.
• Reviews physician schedules prior to scheduled procedures to ensure all have been pre-certified or authorized.
• Reviews benefits to ensure patient has adequate coverage and communicates high out-of-pocket expenses to the Financial Counseling team.
• Notates patient's account with all information relevant to the authorization and pre-certification process, including filling out Structured Data fields in eCW referral.
• Faxes/uploads required pre-certification paperwork to insurance company, adjuster or medical review department to ensure authorization is obtained.
• Responsible for pre-certification process in its entirety, including communicating denials and initiating appeals.
• Manages all workers' compensation and auto pre-certifications due to additional time required by these payers to obtain approval.

Skills

Medical terminology

Pre-certification basics

Medical office operations

Education

High School diploma or GED

Tools

MS Office Suite

Job description

The Pre-Certification Representative at Rothman Orthopaedics in Center City, Philadelphia ensures accurate, efficient processing and communication with insurance companies for pre-certification and authorization of procedures. You will review requests, verify benefits and schedules, document all details in patient records, and coordinate with Financial Counseling to address high out-of-pocket costs.

This role starts in-office with training, then remote eligibility is available after training,