Remote Pre-Certification Specialist (Orthopedics)

Orthos Inc; Mishawaka (IN); On-site; USD 42,000 - 60,000; Full time

Job summary

Orthos Inc. seeks a Pre-Certification Specialist to coordinate the referral and pre-authorization process for orthopedic services. You will work with physicians, clinical staff, insurers, and other healthcare providers to ensure timely authorizations and accurate documentation.

Experience with orthopedics and spine terminology is preferred. Strong communication and organizational skills are essential as you manage in- and outpatient referrals, verify benefits, and maintain confidential patient

Qualifications

• High school diploma or equivalent; college coursework or certification preferred.
• Excellent verbal and written communication skills, especially over the phone, with patients, physicians, colleagues, and insurance representatives.
• Ability to efficiently gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient with office software; ability to navigate multiple systems; typing ~50 WPM.
• Knowledge of insurance policies, payer requirements, medical terminology, and clinical workflows.
• Strong organizational and analytical skills with attention to detail.

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 related data.
• Field inquiries regarding prescription benefits and assist with prescription verification.
• Maintain confidentiality of medical records and patient information per requirements.
• Contribute to updates on payer requirements, industry trends, and data analytics initiatives.
• Perform other duties as assigned.

Skills

Communication

Attention to detail

Organization

Tech proficiency

Remote work

Adaptability

Typing speed 50 WPM

Education

High school diploma

College coursework or certification

Tools

Payer portals

Office software

Job description

Orthos Inc. seeks a Pre-Certification Specialist to coordinate the referral and pre-authorization process for orthopedic services. You will work with physicians, clinical staff, insurers, and other healthcare providers to ensure timely authorizations and accurate documentation.

Experience with orthopedics and spine terminology is preferred. Strong communication and organizational skills are essential as you manage in- and outpatient referrals, verify benefits, and maintain confidential patient