[Hiring] Pre-Certification Specialist @Optim

Role Description

Pre-certs all surgeries prior to day of surgery and follows up with insurance companies if diagnosis or procedures changed. Must be familiar with ICD-9 and CPT code books.

Qualifications

• High School Diploma or GED
• Successful completion of a course in Medical Terminology

Requirements

• Minimum of one year experience in a Medical Office
• Computer Experience

Typical Physical Demands

• Work may require sitting for long periods of time
• Stooping, bending, and stretching for files and supplies
• Occasionally lifting files or paper weighing up to 30 pounds
• Requires manual dexterity sufficient to operate a keyboard, type, operate a calculator, telephone, copier, and other office equipment
• Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts
• Necessary to view and type on computer screens for long periods
• Work in an environment which can be very stressful

Typical Working Conditions

• Work is performed in an office environment
• Involves frequent contact with staff, patients, insurance company representatives, and the public
• Work may be stressful at times
• Contact may involve dealing with angry or upset people

Duties

• Reviews patients’ medical records
• Works with medical and other staff in coordinating medical information and patient charts
• Responsible for pre-certing all surgeries, if required by ICD-9 code with the appropriate insurance company
• Follows-up with insurance companies ensuring that coverage is in effect
• Documents all actions and maintains permanent record in patients’ chart
• Answers patient questions and inquiries regarding the precert status of their surgeries
• Maintains strict confidentiality of sensitive information
• Performs related work as required

Performance Requirements

• Knowledge of medical terminology
• Knowledge of grammar, spelling, and punctuation to type correspondence
• Knowledge of insurance industry
• Skill in operating a computer and photocopy machine
• Ability to read, understand, and follow oral and written instruction
• Ability to maintain confidentiality of sensitive information
• Ability to sort and file materials correctly by alphabetic or numeric systems
• Ability to speak clearly and concisely
• Ability to establish and maintain effective working relationships with patients, employees, and the public

Certificate/License

• None

Alternative to Minimum Qualifications

• Additional appropriate education may be substituted for experience