Pre-Certification Specialist

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

Skills & Requirements Qualifications Orthos is a leading-edge data analytics company, created to help orthopedic practices solve their biggest challenges. Our software helps revenue cycle teams process claims faster, hold insurance companies accountable, provide transparency into the performance of the practice, all while contributing to a better overall patient experience. We help orthopedic providers keep their focus on care while we ensure that their business operations and revenue cycle management processes perform to the highest standards.