Pre Certification Specialist - Orthopedics

ProMedica; Toledo (OH); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Flexible benefits

Disability accommodation (ADAAA)

Job summary

ProMedica's Wildwood Orthopaedic & Spine Hospital in Toledo, OH is seeking a Pre-Certification Specialist. This full-time role handles prior authorization and certification for orthopedic surgeries and injections with payers, ensuring timely approval.

Candidates should have an Associate degree or 5 years of Billing/Insurance Verification experience, plus familiarity with ICD10 and CPT codes and medical office practice. You will maintain coding knowledge and navigate payer criteria.

Qualifications

• Associate degree or 5 years of Billing/Insurance Verification experience.
• Familiarity with ICD10 and CPT codes applicable to services rendered.
• 5 years of relatable or equivalent experience in medical office.

Responsibilities

• Pre-Certification Specialist performs prior authorization and certification for services with payers.
• Maintain working knowledge of medical criteria relating to prior authorization requirements by third-party payers.

Skills

Billing/Insurance Verification

ICD10 and CPT knowledge

Education

Associate degree

Job description

Location:

Wildwood Orthopaedic & Spine Hospital

Department:

Orthopaedics

Weekly Hours:

40

Status:

Full time

Shift:

Days (United States of America)

Job Summary:

When ProMedica patients prepare for orthopaedic surgeries and injections, the Pre-Certification Specialist performs prior authorization and certification for the services with payers.

You will have a general understanding of coding for surgeries and injections and keep a working knowledge of medical criteria relating to prior authorization requirements by third-party payers.

The above summary is intended to describe the general nature and level of work performed in this role. It should not be considered exhaustive.

REQUIREMENTS

• Associate degree or 5 years of Billing/Insurance Verification experience
• Familiarity with ICD10 and CPT codes applicable to services rendered
• 5 years of relatable or equivalent experience in medical office

PREFERRED REQUIREMENTS

• Specific knowledge of medical payers

ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health.For more information about ProMedica, please visit promedica.org/aboutus.

Benefits:

We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being. It’s what makes us one of the best places to work, and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [e-mail]

Equal Opportunity Employer/Drug-Free Workplace