Insurance Precert Specialist

Company: Orthopedic Associates of Flower Mound, PLLC
Location: Flower Mound
Posted on: June 20, 2022

Job Description:

Job DescriptionSUMMARY: Provides assistance with various healthcare services following established policies and protocols. Knowledge of navigating various web sites as well as contacting insurance companies to secure authorizations for surgeries, MRI and visco injections. DUTIES AND RESPONSIBILITIES:Precert surgical procedures prior to surgeryPrecert visco supplementation injectionsPrecert MRI proceduresCalculate patients estimate for procedures Verify patient benefits prior to proceduresMust be able to appeal denied claims for surgeries, visco or MRI if neededFollow-up with insurance companies on outstanding claims Understand peer reviews and schedule if necessaryAbility to communicate with clinical staff Ability to read and understand an explanation of benefits and convey to patientExhibits a high degree of courtesy, tact, and poise when interacting with patients, families, and other healthcare professionals.Adjusts to fluctuating peaks in patient flow, acuity, and other operational demands while maintaining quality.Performs other related duties as assigned by management. QUALIFICATIONS:High school diploma.3+ years of insurance and medical billing experienceComplete understanding of managed care products (i.e. PPO, HMO, POS, Workers Compensation, Medicare Replacement Plans, Exchange PlansMulti- tasking skills are essentialWorking knowledge of ICD 10 and CPT CodesProficient at reading and understanding explanation of benefitsAbility to communicate with the clinical staff Multi-tasking skills are essentialCommitment to excellence and high standardsAble to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.Ability to understand and adhere to established policies, procedures, and protocols.Ability to manage priorities and workflowWorking knowledge of ICD 10 COMPETENCIES: Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. PHYSICAL DEMANDS AND WORK ENVIRONMENT:Occasionally required to standOccasionally required to walkContinually required to sitFrequently required to utilize hand and finger dexterityOccasionally required to climb, balance, bend, stoop, kneel or crawlFrequently required to talk or hearWhile performing the duties of this job, the noise level in the work environment is usually very quiet The employee must occasionally lift and /or move more than 5 pounds The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or physical requirements. Nothing in this job description restricts managements right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Keywords: Orthopedic Associates of Flower Mound, PLLC, Flower Mound , Insurance Precert Specialist, Other , Flower Mound, Texas