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 organized list of scheduled surgeries and monitor their status in the pre-certification process.
• Verify insurance eligibility and benefits via phone and/or internet access, updating policy information 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.
• 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.
• Supply patients with written or verbal estimates of surgical codes and fees upon request.
• Communicate effectively with patients about the billing process and their financial expectations pre-operatively.
• Collect pre-payments from patients as necessary.
• Notify patients with past due accounts of the pre-payment policy for elective surgery.
• Avoid collection of pre-payments from patients for non-elective procedures.
• 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 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.