Pre-Certification Medical Authorization Specialist - Remote

Position Overview:

As a Pre-certification Specialist, you will be responsible for communicating and maintaining information flow in the managed care referral process for contracted health plans.

Essential Duties & Responsibilities:

Oversee the managed care in-patient and outpatient referral and pre-authorization process

Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process

Maintain referral and authorization records documentation

Verify insurance for in-network eligibility and benefits

Field calls for prescription benefits questions and prescription verification

Contact referring physicians and secure authorizations for treatment

Communicate with hospitals to obtain pre-certification numbers

Maintain strict confidentiality required related to medical records and other data

Participate in professional development opportunities to stay current with health care practices and trends

Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office

Other duties as assigned

Required Skills:

High school diploma or equivalent, college courses, or certificate preferred

Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)

Ability to efficiently gather, organize, and comprehend insurance and/ or account information

Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill

Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology

Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo

Ability to learn quickly and contribute ideas that make the team, processes, and solutions better

Share our values: resilience, altruism, communication, achievement, and determination

Preferred Skills:

Two or more years of experience working in pre-certification or managed care

Work Location:

This is a remote opportunity but must reside in one of the following states: Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, or Texas.