Remote Pre-Certification Specialist (Orthopedics)

Orthos Inc; Illinois; On-site; USD 42,000 - 64,000; Full time

Job summary

Orthos Inc is seeking a Pre-Certification Specialist to coordinate and maintain the flow of information through the managed care referral and authorization process.

You will work closely with physicians, clinical staff, insurance carriers, and hospitals to obtain authorizations for orthopedic services, verify coverage, and document pre-certification numbers while maintaining confidentiality and accuracy. This role supports data analytics for the modern orthopedic business office.

Qualifications

• High school diploma or equivalent required.
• Excellent verbal and written communication skills, especially on the phone.
• Ability to gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient with multiple software systems in an office environment; ~50 WPM.
• Knowledge of insurance policies, payer requirements, medical terminology, and clinical workflows.
• Strong organizational and analytical skills with attention to detail.
• Ability to learn quickly and adapt to changing requirements in a remote setting.
• Commitment to resilience, altruism, communication, achievement and 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 and document pre-certification numbers.
• Consult with physicians, nurses, staff, and providers regarding referral and pre-certification requirements.
• Maintain accurate and timely documentation of referrals, authorizations, and related information.
• Field inquiries regarding prescription benefits and assist with prescription verification as applicable.
• Maintain strict confidentiality of medical records and patient information.

Skills

Communication skills

Remote work

Documentation

Organizational skills

Analytical thinking

Fast learner

Education

High school diploma

College coursework or certification

Tools

Office software

Job description

Orthos Inc is seeking a Pre-Certification Specialist to coordinate and maintain the flow of information through the managed care referral and authorization process.

You will work closely with physicians, clinical staff, insurance carriers, and hospitals to obtain authorizations for orthopedic services, verify coverage, and document pre-certification numbers while maintaining confidentiality and accuracy. This role supports data analytics for the modern orthopedic business office.