Precertification Specialist - Atlanta, GA
Full Time
Atlanta, GA 30326
Posted
Job description
Alliance Spine and Pain Centers is looking for a Full-Time Pre-Certification Specialist for our Buckhead location. This is a Monday-Friday position with a full benefits package.
SUMMARY
Responsible for obtaining approval from insurance companies for medical procedures and imaging services provided by Alliance Spine and Pain Center providers.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Obtain pre-certification for medical procedures and imaging studies
- Review and submit clinical information for medical necessity
- Verify medical insurance policies for procedure coverage
- Follow-up with insurance company and patients
- Data entry
- Strong knowledge of government payers (VA etc.)
- Place calls to various health plans to obtain appropriate pre-certification prior to the patient’s appointment
- Develop effective relations with managed care representative as well as providers and ISPM staff
- Develop and submit supporting data and reports as requested by management
- Other duties may be assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
- High school diploma or equivalent
- PC proficiency
- Data entry skill
- Organization and attention to detail
- Working knowledge of medical terminology
- ICD-10 and CPT codes
- Pre-certification and authorization experience in specialist office and radiology
- Insurance verification experience ( strongly preferred)
Communication Skills:
Strong customer service skills. Ability to maintain good relationships with insurance representatives. Ability to effectively give and receive information from insurance carries, providers and ISPM employees.
Reasoning Ability:
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Computer Skills:
Working knowledge of Eclinical. Basic knowledge of Microsoft Office.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to walk and use hands to finger, handle, or feel. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 100 pounds. Specific vision abilities required by this job include close vision and distance vision.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is occasionally exposed to work near moving mechanical parts; fumes or airborne particles and toxic or caustic chemicals. The noise level in the work environment is usually moderate.
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