Pre Certification Collection Specialist

About the role

We are currently searching for a Pre-Certification Collection Specialist to join our Utilization Review team in the OrthoCarolina Business Office in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs.

Essential Functions

• Serves as liaison between the patient, insurance company, physician, and facility.
• Confirms eligibility, benefits and precertification with insurance carriers for patient's scheduled with Physician and facility.
• Responsible to pre-collect from patients including unpaid, true patient current balance, patient's estimated financial responsibility up to and including entire Out of Pocket when necessary.
• Responsible for tracking the account from notification of scheduled appointment including same day and next day add-ons for authorization as well as pre-collection of patient financial responsibility.
• Responsible for identifying and correcting internal problems within assigned accounts to expedite payments from insurance companies.
• Responsible for using online tools for benefits, reviewing medical criteria/policy, prior plan approval (PPA) requirements, initiating and obtaining authorizations.

Skills And Abilities

• Must have knowledge of physician, facility and hospital pre-certification.

Qualifications

• Skills: Accounts Receivable (AR), Customer Service, Data Entry, Documentations, Office Management, Patient Account Management, Patient Care, Payment Analysis
• Education
• Certifications
• Language

Benefits

• Paid company holidays
• Wellness programs
• Tuition reimbursement