Remote Pre-Certification Specialist – Orthopedics

Orthos Inc; Indiana (PA); 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 other healthcare providers to ensure timely and accurate authorizations for patient services. Experience with orthopedics, pain management, and spine-related terminology is preferred.

Qualifications

• High school diploma or equivalent required; college coursework or certification preferred.
• Excellent verbal and written communication over the phone and with patients and providers.
• Ability to efficiently gather, organize, review, and understand insurance and authorization data.
• Proficient computer skills and ability to navigate multiple software systems; approx 50 WPM.
• Knowledge of insurance policies, payer requirements, medical terminology, and clinical workflows.
• Strong organizational and analytical skills with attention to detail; able to learn quickly and work remotely.

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 other healthcare facilities to obtain and document pre-certification numbers.
• Consult with physicians, nurses, staff, and healthcare providers regarding referral and pre-certification requirements.
• Maintain accurate and timely documentation of referrals, authorizations, and related insurance information.
• Field inquiries regarding prescription benefits and assist with prescription verification, as applicable.
• Maintain strict confidentiality of medical records, patient information, and other sensitive data in accordance with applicable requirements.
• Participate in professional development opportunities to remain current on healthcare practices, payer requirements, and industry trends.
• Actively contribute to the company’s efforts to develop innovative data and analytics solutions for the modern orthopedic business office.
• Perform other duties as assigned.

Skills

Communication skills

Remote work ability

Insurance verification

Documentation & data entry

Organizational skills

Education

High school diploma or equivalent

College coursework or certification preferred

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 other healthcare providers to ensure timely and accurate authorizations for patient services. Experience with orthopedics, pain management, and spine-related terminology is preferred.