Remote Pre-Certification Specialist – Orthopedics

Orthos Inc; Iowa (LA); On-site; USD 42,000 - 52,000; Full time

Job summary

Orthos Inc. is seeking a Pre-Certification Specialist for a full-time remote position (Mon-Fri, 8-hour shifts). You will coordinate referrals and authorizations to keep orthopedic services moving efficiently.

You will verify benefits, contact physicians and carriers for authorizations, and document pre-certification numbers while respecting patient privacy and confidentiality. Experience with orthopedics or spine terminology is preferred; strong communication, organization, and tech skills are

Qualifications

• High school diploma or equivalent; college coursework preferred.
• Excellent verbal and written communication, especially over the phone.
• Ability to gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient with multiple software systems; typing ~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, adapt to changing requirements, and work remotely.
• Commitment to our values of 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 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.
• Maintain strict confidentiality of medical records, patient information, and other sensitive data.
• 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

Remote work

Insurance knowledge

Analytical skills

Organization

Education

High school diploma

Tools

Office software

Job description

Orthos Inc. is seeking a Pre-Certification Specialist for a full-time remote position (Mon-Fri, 8-hour shifts). You will coordinate referrals and authorizations to keep orthopedic services moving efficiently.

You will verify benefits, contact physicians and carriers for authorizations, and document pre-certification numbers while respecting patient privacy and confidentiality. Experience with orthopedics or spine terminology is preferred; strong communication, organization, and tech skills are