Remote Pre-Certification Specialist - Orthopedics/Spine

Orthos Inc; Arkansas; On-site; USD 42,000 - 66,000; Full time

Job summary

Orthos Inc. seeks a Pre-Certification Specialist to coordinate and maintain the flow of information throughout managed care referrals and pre-authorization processes.

You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely authorizations for patient services. Experience or familiarity with orthopedics, pain management, and spine-related terminology is required.

Qualifications

• High school diploma or equivalent required; college coursework or certification preferred.
• Excellent verbal and written communication, particularly over the phone, with the ability to establish and maintain positive working relationships with patients, physicians, colleagues, insurance representatives, and other stakeholders.
• Ability to efficiently gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient computer skills with the ability to navigate multiple software systems in an office environment; typing speed of approximately 50 WPM preferred.
• Knowledge of, or demonstrated ability to learn, insurance policies and procedures, payer requirements, medical terminology, and clinical workflows.
• Strong organizational and analytical skills with excellent attention to detail.
• Ability to learn quickly, adapt to changing requirements, and contribute ideas that improve team processes and solutions.
• Ability to work independently and effectively in a remote environment.

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 for treatment.
• 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

Organizational skills

Analytical skills

Computer proficiency

Typing speed 50 WPM

Remote work ability

Education

High school diploma or equivalent

Job description

Orthos Inc. seeks a Pre-Certification Specialist to coordinate and maintain the flow of information throughout managed care referrals and pre-authorization processes.

You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely authorizations for patient services. Experience or familiarity with orthopedics, pain management, and spine-related terminology is required.