Precertification Specialist

Orthopedic One; Gahanna (OH); On-site; USD 35,000 - 42,000; Full time

Job summary

Orthopedic One is seeking an Administration/Health Information staff member in Westerville, OH, to handle pre-certification, insurance verification, and EMR documentation for therapy services.

The role requires a high school diploma, customer service experience, basic computer skills, and precertification experience, with CPR/AED certification preferred. Strong communication and attention to detail are essential for accurate benefit information for patients and providers.

Qualifications

• High School Diploma or equivalent required.
• Customer service experience and basic computer skills required, preferably in a Windows environment with electronic medical records software.
• Medical terminology or other previous medical office experience desirable.
• Precertification experience required.
• Must maintain CPR/AED certification.

Responsibilities

• Pre-certification: Timely verification and/or pre-certification for evaluation and treatment as required by insurance provider and documents appropriately.
• Verify insurance coverage and benefits; verify eligibility and benefits online or by phone; document necessary pre-authorization details in EMR.
• Documentation: Record benefit information into the EMR and coordinate with staff to review benefits with patients; provide written estimates of covered therapy benefits.

Skills

Customer service

Basic computer skills

EMR experience

CPR/AED certification

Education

High School Diploma or equivalent

Job description

• Schedule - Shift Regular Full Time - Day Shift

Responsible for pre-certification of patient appointments and procedures according to Therapy Services protocols. Interactions with patients and insurance companies must be courteous, professional and efficient.

RESPONSIBILITIES AND ACCOUNTABILITIES

• Pre-certification:
  • Timely verification and/or pre-certification for evaluation and treatment as required by insurance provider and documents appropriately. Verify primary and secondary insurance coverage for both in/out of network benefits. Verify insurance eligibility and benefits online or by phone which necessitates long periods of time on telephone with insurance representatives. Verify co-pays, deductibles, co-insurance, covered and non-covered services. Re-verifies existing patient insurance coverage annually or as required. Updates insurance policy information in EMR as required, such as completion of Notification of Benefits form. Verify receipt of all necessary pre-authorization documents prior to treatment. Receives referrals and enters information into EMR including authorization numbers, PCP information, visits allotted and expiration date or any other notes pertaining to insurance plan.
• Documentation:
  • Document clear and concise benefit information into the EMR system. Coordinates and reviews information with staff so they can review benefits with patients Provide patients with estimated written documentation of covered therapy benefits per the patient’s insurance coverage
• Business Office/Billing:
  • Collects patient and insurance information required to update EMR and patient record including photocopying or scanning insurance cards.

Scan and file documents into EMR including NOB and insurance verification documents

Various clerical duties including copying, faxing, scanning, and filing

Other duties assigned in support of clinicians or physicians

TEAMWORK

• Teamwork:
  • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision. Works cooperatively and refrains from participating in negative conversations. Shares knowledge and insights with co-workers in a constructive manner. Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers. Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.

POLICIES AND PROCEDURES

• Policies and Procedures
  • Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents. Provides assistance and support to leadership in implementing policies and procedures as necessary. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

QUALIFICATIONS

Education, Experience, Certification and Licensure Requirements:

High School Diploma or equivalent required. Customer service experience and basic computer skills required, preferably in a windows environment with electronic medical records software. Medical terminology or other previous medical office experience desirable. Precertification experience required. Must maintain CPR/AED certification.

Job Category Administration/Health Information
Location Westerville, OH, United States