Pre Certification Specialist - Orthopedics

ProMedica Central Physicians; Toledo (OH); On-site; USD 42,000 - 66,000; Full time

Job summary

ProMedica Wildwood Orthopaedic & Spine Hospital is seeking a Pre-Certification Specialist to perform prior authorizations and certifications for orthopaedic procedures with payers. You will apply knowledge of coding for surgeries and injections and stay current with medical criteria used by third-party payers.

The role requires an associate degree or 5 years of billing/insurance verification experience, familiarity with ICD10/CPT codes, and 5 years in a medical office.

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.

Skills

Billing/Insurance Verification

ICD10/CPT knowledge

Medical office experience

Education

Associate degree

Job description

Location:Wildwood Orthopaedic & Spine HospitalDepartment:OrthopaedicsWeekly Hours:40Status:Full timeShift: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.REQUIREMENTSAssociate degree or 5 years of Billing/Insurance Verification experienceFamiliarity with ICD10 and CPT codes applicable to services rendered5 years of relatable or equivalent experience in medical officePREFERRED REQUIREMENTSSpecific knowledge of medical payersProMedica 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] Opportunity Employer/Drug-Free Workplace