Remote Pre-Certification Specialist – Orthopedics

Orthos Inc; Arizona; On-site; USD 42,000 - 65,000; Full time

Job summary

Orthos Inc. is seeking a Pre-Certification Specialist to coordinate and maintain the flow of information in the managed care referral and authorization process. You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely authorizations for patient services.

Experience with orthopedics, pain management, and spine terminology is required. This is a full-time remote role (M-F 8-hour shift 7:30am–5:30pm); candidates must reside in listed states.

Qualifications

• High school diploma or equivalent required; college coursework or relevant certification preferred.
• Excellent verbal and written communication skills, especially over the phone, with patients, physicians, and staff.
• Ability to efficiently gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient computer skills; ability to navigate multiple software systems; typing ~50 WPM preferred.
• Knowledge of insurance policies, payer requirements, medical terminology, and clinical workflows.
• Strong organizational and analytical skills with attention to detail.
• Ability to learn quickly, adapt to changing requirements, and contribute ideas for process improvements.
• Ability to work independently and effectively in a remote environment.
• Commitment to company values: resilience, altruism, communication, achievement, determination.

Responsibilities

• Manage inpatient and outpatient referral and pre-authorization processes.
• Verify insurance coverage, in-network eligibility, benefits, and authorization requirements.
• Contact referring physicians and insurance carriers to obtain required authorizations.
• Communicate with hospitals and healthcare facilities to obtain pre-certification numbers.
• Consult with physicians and staff regarding referral and pre-certification requirements.
• Maintain accurate and timely documentation of referrals, authorizations, and insurance information.
• Field inquiries regarding prescription benefits and assist with prescription verification, as applicable.
• Maintain confidentiality of medical records and patient information.

Skills

Strong communication

Remote work capability

Attention to detail

Organizational skills

Analytical skills

Medical terminology

Ability to learn quickly

Education

High school diploma or equivalent

College coursework or relevant certification

Tools

Office software

Payer portals

Job description

Orthos Inc. is seeking a Pre-Certification Specialist to coordinate and maintain the flow of information in the managed care referral and authorization process. You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely authorizations for patient services.

Experience with orthopedics, pain management, and spine terminology is required. This is a full-time remote role (M-F 8-hour shift 7:30am–5:30pm); candidates must reside in listed states.