Pre-Certification Procedure Scheduler

Job Type

Full-time

Description

General Job Summary: Vital to the success of organization with providing OrthoCincy's patients and visitors with a premier orthopaedic experience and focusing on their individual needs. Responsible for pre-certifying tests and procedures.

Essential Job Functions:

Provides excellent customer service to patients by addressing their concerns and providing necessary information.

Prepares, organizes, prioritizes documents and communicates all necessary paperwork and information needed by insurance companies for the prior authorization process.

Ability to achieve minimal denials due to prior authorization accuracy.

Obtain authorizations for imaging procedures, surgical procedures, and injections from various insurance providers.

Verify patients' insurance benefits and eligibility and obtain the required pre-authorization for treatment or services.

Provides patient education per provider protocol.

Establish and maintain effective working relationships with patients, providers, co-workers and external contacts regarding procedures and testing.

Maintain patient information in an electronic health records and practice management system.

Answer messages, emails, and/or voice mails in a timely and professional manner.

Demonstrates sound judgement by notifying providers/teams regarding questionable findings and concerns in an urgent manner.

Compliance with HIPAA guidelines.

Takes initiative in performing additional tasks that may be necessary or in the best interest of the practice.

Requirements

Education/ Experience: High school diploma or equivalent required. Medical certification required with two to five years' experience as a Medical Assistant preferred. CPR/AED and First Aid Certification preferred.

Other Requirements. Must be patient care oriented with a team environment focus. Schedules will change as department needs change, including overtime and weekends. Weekly travel between locations.

Performance Requirements:

Knowledge:

Knowledge of OrthoCincy's Mission, Vision and Values.

Knowledge of customer service principles and techniques.

Knowledge of electronic health records and practice management systems.

Knowledge of medical terminology.

Knowledge of HIPAA guidelines.

General knowledge of insurance guidelines.

Skills:

Strong interpersonal and teamwork skills.

Strong critical thinking and decision-making skills.

Strong customer service skills.

Proficiency in computer systems and software used for pre-certification purposes.

Strong communication skills in a professional manner during stressful and sensitive situations with patients of all ages.

Abilities:

Ability to project a pleasant and professional image.

Ability to be self-directed and motivated in order to proactively plan, prioritize, and complete tasks.

Ability to demonstrate compassion while caring for others

Ability to analyze situations and respond appropriately.

Ability to consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.

Demonstrates regular, consistent, and punctual attendance.

Exhibits desire to continuously learn, improve service delivery, and work in a team environment.

Equipment Operated: Standard office equipment.

Work Environment: Medical office.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day. Repetitive data entry. Must be able to remain focused and attentive without distractions (i.e. personal devices).