Pre-Certification Medical Authorization Specialist - Remote

Position Overview

As a Pre-certification Specialist, you will be responsible for communicating and maintaining information flow in the managed care referral process for contracted health plans.

Essential Duties & Responsibilities

• Oversee the managed care in-patient and outpatient referral and pre-authorization process

• Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process

• Maintain referral and authorization records documentation

• Verify insurance for in-network eligibility and benefits

• Field calls for prescription benefits questions and prescription verification

• Contact referring physicians and secure authorizations for treatment

• Communicate with hospitals to obtain pre-certification numbers

• Maintain strict confidentiality required related to medical records and other data

• Participate in professional development opportunities to stay current with health care practices and trends

• Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office

• Other duties as assigned

Required Skills

• High school diploma or equivalent, college courses, or certificate preferred

• Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)

• Ability to efficiently gather, organize, and comprehend insurance and/ or account information

• Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill

• Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology

• Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo

• Ability to learn quickly and contribute ideas that make the team, processes, and solutions better

• Share our values: resilience, altruism, communication, achievement, and determination

Preferred Skills

• Two or more years of experience working in pre-certification or managed care

Work Location

This is a remote opportunity but must reside in one of the following states: Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, or Texas.