Precertification Specialist

Borland Groover; Jacksonville (FL); On-site; USD 38,000 - 54,000; Full time

Job summary

Borland Groover is seeking a Precertification Specialist to join the Patient Access department in Jacksonville. The role ensures referrals and/or authorizations are secured so clinics and ambulatory surgical centers are reimbursed for services rendered.

Responsibilities include verifying eligibility, obtaining referrals and precertifications, handling patient inquiries, and coordinating with insurance providers to cover procedures. HIPAA training is required and compliance must be maintained.

Qualifications

• Able to communicate effectively with patients and staff in writing and verbally.
• Ability to manage multiple tasks in a possibly stressful environment.
• Strong attention to detail and accuracy in processing referrals and authorizations.

Responsibilities

• Verify benefits and/or eligibility of patients to be seen.
• Obtain referrals as needed before physician visits.
• Obtain precertifications before tests and procedures.
• Answer calls from patients to explain insurance requirements or schedule appointments.
• Conduct outbound calls to patients as needed.
• Process payment arrangements for patients when necessary.
• Contact insurance companies to inquire about benefits or authorizations.
• Assist satellite office staff with insurance or precertification understanding.
• Address nurse or patient portal inquiries for the department.

Skills

Communication

Time management

Critical thinking

Compassion

Education

High school diploma

Job description

POSITION SUMMARY

The Precertification S p ecialist at Borland Groover is a part of the Patient Access department. The general duty ofthisposition is to ensure each patient has a referral and/or authorization so that the clinic and ambulatory surgical centers will be reimbursed for all services rendered .

ESSENTIAL JOB FUNCTIONS

• Verify benefits and/or eligibility of patients that are scheduled to be seen.
• Obtain a referral as needed before a patient is seen by a physician.
• Obtain precertifications before tests and procedure(s) are performed.
• Take incoming calls from patients to help them better understand their insurance and requirements and/or to schedule or reschedule patient appointments as needed.
• Conduct outbound calls to patients as necessary.
• Complete payment arrangements for patients when necessary.
• Contact insurance companies to inquire about benefits or authorizations requirements.
• Assist the satellite office personnel with insurance or precertification comprehension as needed.
• Answer nurse or patient portal inquiries assigned to the department.
• This job requires access to Personal Health Information (PHI), HIPAA training is required, and HIPAA compliance is expected.
• Must follow the organization’s Code of Conduct.
• Must participate in the Compliance Program Initiatives and reporting and Compliance Issues.
• Handle all other duties as assigned.

COMPETENCIES

• Communication - Exhibits good listening and comprehension. Expresses ideas and thoughts in written form. Expresses ideas and thoughts verbally. Keeps others adequately informed. Selects and uses appropriate communication methods.
• Critical Thinking and Problem Solving - The ability to handle complex situations in the workplace and calmly develop creative solutions.
• Compassion - Exhibits empathy or real concern for patients coupled with a desire to take action to address the patient’s needs.
• Time-Management - The ability to plan your duties ahead of time and leveraging technology to help you do so efficiently.

GENERAL QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Ability to communicate effectively with patients, physicians and staff both verbally and in writing.
• Works well with patients, physicians, and staff.
• Ability to handle multiple tasks in a possibly stressful environment.
• Ability to handle patient issues in a tact, professional way.

EDUCATION AND EXPERIENCE

• High School diploma required. Previous experience is required.
• Previous experience preferred but not required .

POSITION LOCATION

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Physical Demands

• Sitting: Prolonged periods of sitting at a desk and working on a computer: essential
• Walking: Must be able to access and navigate each department at the organization’s facilities: essential
• Pushing/Pulling: marginal
• Repetitive motion: marginal
• Reaching: marginal

Emotional Demands

• Intense customer interaction: essential

Mental/Sensory Demands

• Health Insurance
• Vision Insurance
• 401K Retirement Plan
• Life Insurance
• Short- and Long-term disability
• Profit Sharing
• Supplemental Insurance
• Education and Tuition Reimbursement funding
• Employee Assistance Program (EAP)
• Paid Time Off (PTO)
• Paid Holidays

IMPORTANT NOTE

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be an exhausted list of duties, responsibilities, and skills. Borland Groover is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We thank all applicants for their interest. However, only those selected for an interview will be contacted.