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