Pre-Certification and Scheduling Specialist

As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of Northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care that our patients need to keep moving and keep enjoying their life.

The Pre-Certification and Scheduling Specialist is responsible for the following tasks:

Precertification/Prior Authorization & Scheduling:

o MRI

o PT/DME

o Surgery

o In Office Injections

The Pre-Certification and Scheduling Specialist is responsible for completing the pre-authorization and scheduling process for MRI and surgery. The Precertification and Scheduling Specialist is expected to provide the highest level of service to patients, fellow employees, and outside sources through ensuring that insurance benefits and pre-certification is complete, accurate, timely, and fully documented. Manual dexterity is required and the ability to concentrate on detail amid other activity. Must follow have the capacity to specific protocols in scheduling and in the collection of insurance information.

Essential Functions:

• Obtain authorization via payer website or by phone and follow up regularly on pending cases. • Prioritize incoming authorization requests according to urgency. • Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations. • Initiate appeals for denied authorizations. • Schedule and coordinate patient surgeries and MRI’s. • Communicate with surgical facilities and send all necessary surgical forms. • Review surgery schedule with facilities the day before surgery; create and send email to physicians. • Meet deadlines as determined by the date of procedure. • Respond to clinic questions regarding payer medical policy guidelines. • Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order. • Contact patients to discuss authorization status. • Document all work in practice management system. • Other duties as assigned.

Competencies:

• Strong attention to details.

• Time Management, prioritization, and sense of urgency

• Basic understanding of insurance rules and regulations

• CPT/ICD10 knowledge

• Medical terminology

• HIPAA compliance

Required Skills:

·        Maintains composure and operates with emotional intelligence.

·        Strong attention to detail.

·        Receptive to and responsive to feedback.

·        Excellent verbal and written communication skills.

·        Time management, prioritization, and sense of urgency.

Preferred Skills:

·        Work experience in a medical office setting preferred but will train the right candidate.

·        Healthcare related background including surgical terminology preferred.

·        Scheduling and pre-authorization experience preferred.

·        Must be at least 18 years of age.

·        Must have reliable transportation.

·        Proficiency in Microsoft Word, Excel and Outlook preferred.

·        Digital literacy.

Required Education:

High school diploma or the equivalent

Physical Requirements:

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts.  Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear.  The employee must occasionally lift and/or move up to 50 lbs.  While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

Environmental/Working Conditions: 

Work is performed in an office environment. Involves frequent personal and telephone contact with patients and with testing sites and surgery departments. Work may be stressful at times. Interaction with others is constant and interruptive. Contact involves dealing with injured sick people.

Compliance:

All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete required compliance training modules, and report any observations of non-compliance.

EEO Statement:

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

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Last updated on Sep 24, 2024