Surgery Precertification Specialist

Wheaton Eye Clinic; Wheaton (IL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical

Group Life and LTD

Paid Time Off

Paid Holidays

Clothing Allowance

Vision Care Benefits

Voluntary Benefit Offerings - Life,STD

Job summary

Wheaton Eye Clinic in Wheaton, IL seeks a Surgical Precertification Specialist to obtain preauthorizations for outpatient surgeries. This in-office role requires strong communication and customer service, plus knowledge of ICD-10 and medical terminology.

You will liaise with insurance companies, primary care physicians, and utilization management organizations, ensuring timely approvals and minimal cancellations.

Qualifications

• Outstanding communication and customer service skills.
• Knowledge of ICD-10 and medical terminology.
• Ability to read, write and speak clearly and professionally.
• 1-2 years insurance experience with prior authorization processes preferred and 1-2 years medical scheduling experience preferred.

Responsibilities

• Obtain preauthorization for outpatient surgeries from insurance companies.
• Communicate with primary care physicians and utilization management organizations to obtain authorizations.
• Follow up on requests to ensure timely responses and prevent last-minute cancellations.
• Communicate denials and coordinate with surgeon, patient, facility and scheduling staff as needed.
• Investigate denials with the Insurance Department and submit appeals when necessary.
• Assist with urgent add-on surgery authorizations and respond to inquiries from patients and case managers.

Skills

Communication skills

Customer service

Medical terminology

Education

High school diploma or equivalent

Job description

Founded over 80 years ago, the Wheaton Eye Clinic is a nationally recognized multi-subspecialty ophthalmology practice that spans the western suburbs of Chicago and is the largest independent ophthalmology clinic in the Midwest. We pride ourselves on serving the community both as a caring eye care provider and as a reputable employer. Our offices are located in Wheaton, Naperville, Hinsdale, Saint Charles, Bartlett, and Plainfield and an ophthalmology-specific ambulatory surgery center at the main office in Wheaton. We have both Ophthalmologists and Optometrists in every ophthalmic subspecialty are highly respected in the region and have superb relationships with referring colleagues and health systems. Patients travel to Wheaton Eye Clinic from throughout Northern Illinois, as well as from across the United States. Our referring physicians locally, across the United States, and from many international countries, send their patients to Wheaton Eye Clinic because of its unwavering reputation for exceptional patient care. More than 170,000 patient visits occur each year. Our mission at Wheaton Eye Clinic is to provide comprehensive eye care services of the highest quality and value. This dedication to excellence is founded on how we strive to surpass each patient's expectations in the delivery of competent, timely, and compassionate eye care.

Overview:

Under supervision of the Physician Support Manager, the Surgical Precertification Specialist is responsible for obtaining preauthorization/precertification of all outpatient surgeries. The Surgical Precertification Specialist will possess outstanding communication and customer service skills and the ability to handle multiple tasks within a designated time frame. The Specialist will act as a liaison between our organization and insurance companies to promote the Wheaton Eye Clinic’s commitment to exceptional patient care.

HIS ROLE IS MONDAY - FRIDAY 8AM-5PM IN THE OFFICE.

Contact insurance companies, HMO providers and/or local unions to initiate preauthorization for all outpatient surgeries.

Communicate with primary care physicians and utilization management organizations to obtain surgery authorizations for HMO patients; submit clinical information.

Follow up with requests in a timely manner to ensure a response is received with enough notice prior to surgery to prevent last-minute cancellations.

In the event of a denial, the Specialist will communicate the insurance’s decision with the surgeon, patient, facility and Surgery Scheduling staff accordingly.

Work with the Insurance Department staff to investigate all denials, and with assistance from providers, submit appeals as necessary.

Obtain authorizations for urgent add-on surgeries in a timely manner.

Respond to inquiries by telephone and / or written correspondence using quality customer service.

Respond to insurance companies’ or case managers’ requests for additional information.

Respond to requests from primary care physician’s offices for additional information.

Communicate with surgical facilities regarding preauthorization status.

Respond to calls from patients requesting preauthorization information.

Provide accurate, thorough and timely documentation of all information pertinent to patient treatment.

Assist with Surgery Scheduling tasks:

• Answer incoming calls to the department
• Schedule and coordinate surgical appointments by phone
• Coordinate any necessary preoperative testing, preoperative physical or clearance. Review patient’s health history for conditions that may affect surgery.
• Review preoperative and postoperative medications. Advise patients of instructions as guided by physicians' protocols. Enter medication orders through electronic medical records to be prescribed by physicians for surgery.
• Contact primary care physicians and specialists' offices to request history and physical reports or clearances for all surgery locations.

Qualifications:

Education: High school graduate or equivalent

Ability to read, write and speak in a clear and professional manner required

Knowledge of ICD-10 required

1 - 2 years insurance experience with knowledge of prior authorization processes preferred

1 - 2 years medical scheduling experience preferred

General knowledge regarding medical terminology preferred

Full Time Benefits:

• Medical
• Group Life and LTD
• Paid Time Off
• Paid Holidays
• Clothing Allowance
• Vision Care Benefits
• Voluntary Benefit Offerings - Life, STD, Critical Illness, Accident