Surgical Services Precertification Specialist

About the role

This position involves verifying patient insurance benefits and eligibility, obtaining required authorizations, providing procedure codes and fee estimates, and collecting prepayments from patients when necessary.

Responsibilities

• Maintain an organized list of scheduled surgeries and monitor their progress.
• Verify insurance eligibility and benefits using phone and internet access.
• Update insurance policy information in Eyecare as needed.
• Check insurance payment policies for scheduled procedures and obtain prior authorization when required.
• Ensure all necessary pre-authorization documents are received before the procedure.
• Communicate with the facility where the procedure will be performed as needed.
• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
• Notify primary care physicians for managed care plans requiring PCP authorization.
• Provide patients with written or verbal estimates of surgical codes and fees upon request.
• Meet with patients pre-operatively or communicate effectively with them about the billing process and their financial expectations.
• Collect pre-payments from patients when necessary.
• Notify patients with past due accounts of the pre-payment policy for elective surgery.
• Receive payments from patients.
• Assist with check-in and check-out when needed.
• Serve as a resource on insurance, billing, and customer service for reception and cashier staff.
• Monitor the cash box and report the balance to the supervisor and accounting department monthly.
• Perform other duties or functions as assigned.

Requirements

• A minimum of two (2) years' experience in the medical field.
• A strong knowledge of anatomy, physiology, medical terminology, and medical insurance.

Qualifications

• Sedentary work environment.
• Physical activity: talking, hearing, repetitive motion.