Surgical Services Precertification Specialist

POSITION SUMMARY

The Pre-Certification & Insurance Specialist is responsible for verifying patient insurance eligibility and benefits, obtaining prior authorizations, and coordinating pre-certification requirements for scheduled procedures. This position provides patients with procedure estimates, explains financial responsibilities, collects pre-payments when appropriate, and serves as a resource for insurance and billing questions. Success in this role requires exceptional attention to detail, strong communication skills, and a commitment to providing an excellent patient experience.

Essential Responsibilities

• Monitor scheduled surgeries and maintain organized list with status of pre-certification process.
• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in Eyecare as required.
• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
• Verify receipt of all necessary pre-authorization documents prior to procedure.
• Communicate effectively with the facility in which the procedure will be performed as needed.
• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
• Notify primary care physician for managed care plans that require PCP authorization.
• Supply patients with written or verbal estimates of surgical codes and fees upon request.
• Meet with patients pre-operatively or communicate effectively as necessary with patients so they understand the billing process and their financial expectations pre-operatively.
• Collect pre-payment from the patient when necessary. Notify patients with past due accounts of pre-payment policy for elective surgery.
• Absorb 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.
• Monitor cash box and report balance to supervisor and accounting department monthly.
• Perform other duties or functions as assigned.

Education And/Or Experience

• A minimum of two (2) year's experience in the medical field.
• Must have a strong knowledge of anatomy, physiology, medical terminology, and medical insurance.