Pre-Certification Specialist — Weekday Schedule & Growth

Ohio ENT & Allergy Physicians; Columbus (OH); Vor Ort; USD 25.000 - 39.000; Vollzeit

Benefits dieser Stelle

Med/Dental/Vision

Paid Personal Time

Paid Holidays

401K

Paid STD/LTD/Life

Zusammenfassung

Ohio ENT & Allergy Physicians is seeking a highly organized Pre-Certification Specialist to obtain insurance authorizations and verify patient benefits to ensure services are approved before treatment. You will liaison between patients, providers and carriers to meet payer requirements and authorize services.

The role aims to minimize denials and support a positive patient experience in a fast-paced setting.

Qualifikationen

• 1–3 years of healthcare authorization, insurance verification, medical billing, or revenue cycle experience.
• Experience with multiple commercial insurers, Medicare & Medicaid.
• Experience in a physician practice, outpatient clinic, hospital, or specialty healthcare setting.
• Good understanding of insurance plans and medical necessity guidelines.
• Knowledge of medical terminology & anatomy.
• Proficiency with ICD-10 & CPT codes.
• Proficiency with EMR and practice management systems.

Aufgaben

• Verify patient insurance eligibility, benefits, and coverage.
• Obtain prior authorizations and pre-certifications for procedures, testing and services.
• Review physician orders and documentation for authorization requirements.
• Submit authorization requests and records to insurance carriers.
• Monitor approvals, denials, and expirations.
• Follow up on pending requests for timely completion.
• Communicate authorization status and patient financial responsibility to providers, staff, and patients.
• Assist with appeals and reconsideration requests for denied services.
• Maintain documentation in EMR and practice management systems.
• Collaborate with scheduling, clinical, and billing to reduce delays and support revenue cycle performance.

Kenntnisse

Communication skills

Healthcare experience

Attention to detail

Organization

Tools

EMR

Practice management systems

Jobbeschreibung

Ohio ENT & Allergy Physicians is seeking a highly organized Pre-Certification Specialist to obtain insurance authorizations and verify patient benefits to ensure services are approved before treatment. You will liaison between patients, providers and carriers to meet payer requirements and authorize services.

The role aims to minimize denials and support a positive patient experience in a fast-paced setting.