Pre - Authorization Specialist

4 weeks ago

Louisville, United States Ellis and Badenhausen Ortho Full time
Pre Authorization / Pre-certification Specialist

Come join a team where People make the difference We rely heavily on people with the right aptitude, attitude and entrepreneurial spirit to drive our success. Ellis & Badenhausen Orthopaedics, PSC is dedicated to providing the Louisville community with the highest quality of orthopedic service. We will ensure that patient care remains the focus of our medical practice by maintaining an experienced staff and by keeping on the forefront of medical technology and research.

About the role;

To ensure the financial integrity of each patient's account generated to maximize reimbursement. Educate and communicate to patients and/or responsible parties of any financial responsibilities, or insurance issues in order to streamline the process.

Position Title: Pre Authorization / Pre-certification Specialist

Reports to: Office Manager

This position features:

Generous pay and benefits including a 401k and profit-sharing plan

Pre-certification Job Duties
  • Complete all authorization/pre-certification to improve patient satisfaction
  • Contacts insurance company for authorization/precertification requirement, initiate request and deliver pertinent medical records, i.e., chart notes, diagnostic imaging reports, and op notes, to expedite process; obtains patient eligibility and benefits via phone (live/automated) or online portal.
  • Completes and provides estimates to patients
  • Confirms all eligible appointments and scans all pertinent documentation to patient's chart.
  • Notates pertinent information in the system regarding patient insurance verification/pre-certification status and patient financial responsibility.
  • Notifies appropriate staff and clinical team of any problematic insurance issue that may lead to surgery delay.
  • Compiles pertinent medical records information, i.e., chart notes, diagnostic imaging reports, op notes, etc.
  • Reviews and documents insurance and patient correspondence in the system in a timely manner.
  • Provides patient collection advice & benefit interpretations
  • Updates patient information in computer, i.e., insurance information, demographics, etc. when notified of changes by the patient
  • Provides support to verifications, procedure authorizations and patient balance inquiries
  • Displays the highest level of customer service, attentiveness and consideration possible in all surgery cases.
  • Stays abreast of laws and regulations that might affect the organization's policies and procedures
  • Constantly monitors for ways to increase efficiency and reduce risk within the organization
  • Communicates potential risk to the Billing Director
  • Report and follow directives of HIPAA and OSHA compliance officers
  • Any additional duties as assigned
  • Cooperative work attitude toward co-employees, management, patients, visitors, outsourced companies and physicians
  • Ability to promote favorable facility image with physicians and general public
  • Ability to make decisions and solve problems.
  • Ability to analyze and interpret data.
  • Ability to research and prepare comprehensive reports/summaries.
  • Ability to communicate clearly and effectively in writing and verbally.
Qualifications;
  • At least one year of professional experience in medical billing office preferred
  • Strong in Excel and MS Word skills
  • Strong analytical and problem-solving skills with the ability to define root causes of concern as they arise.
  • Strong ethical and moral character references
  • Good communication skills
  • Good computer skills
  • Ability to maintain strict confidentiality
  • Willingness to support and encourage co-workers
  • Accuracy
  • Attention to detail
  • Timeliness
  • Time Organization
  • Little supervision needed to accomplish tasks
  • Skills in computer systems
  • Knowledge of operating systems, word processing, spreadsheets, and 10-key touch
  • Skill in organizing tasks.
  • Attendance
  • Punctuality
  • Ability to follow instructions
  • Ability to meet deadlines
  • Ability to sit for long periods of time, stand, and walk
  • Visual and auditory acuity for frequent use of computer, telephone, and use of other office equipment
  • Manual dexterity using calculator and computer keyboard
  • Standing, sitting 10 hours/day while doing computer input and responding to phone questions. Occasional stress in working with employees and multiple tasks.
  • Well lit and ventilated, with non-hazardous and hazardous equipment
  • Busy office environment

We are an equal opportunity employer

Ellis & Badenhausen Orthopaedics, PSC is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, creed, gender, marital status, sexual orientation, color, religion, national origin, age, disability, veteran status, or any other status protected under local, state, or federal laws. Applicants must be eligible to work in the USA.

  • Authorization Specialist

    4 weeks ago

    Louisville, Colorado, United States Orthopedic Centers of Colorado Full time

    Job DescriptionAt Orthopedic Centers of Colorado, we are seeking a highly skilled Authorization Specialist to join our team. This role is responsible for managing and processing authorization requests for services, procedures, and equipment within the organization.Key Responsibilities:Authorize scheduled procedures, including surgeries, injections,...

  • Pre-Access Specialist

    3 months ago

    Louisville, United States UofL Health Full time

    Overview: The Pre-Access Specialist will be responsible for verifying accurate insurance and demographic information, obtaining or verifying authorization, referrals or precertification, checking medical necessity, creating patient estimates and having financial clearance conversations with patients for outpatient procedures. The Pre-Access Specialist will...

  • Clinical Authorization Specialist

    4 weeks ago

    Louisville, Kentucky, United States UofL Health Full time

    Job SummaryThe Precertification Specialist plays a crucial role in ensuring a seamless patient experience by accurately and efficiently completing prior authorization, medical necessity determination, and financial clearance for hospital services and physician clinics.Key ResponsibilitiesIdentify and obtain necessary clinical documentation to support medical...

  • Prior Authorization Specialist

    3 months ago

    Louisville, United States TEKsystems Full time

    Prior Authorization Specialist needed!!! Description: - Verifies insurance eligibility and benefits of prospects/referrals and determines LHC rate requirements as it relates to in or out of network coverage on a daily basis in an accurate and timely manner. -Communicates patient benefits in a timely manner using the appropriate legacy system and...

  • Prior Authorization Specialist

    2 weeks ago

    Louisville, United States TEKsystems Full time

    Job DescriptionJob DescriptionDescription:- Verifies insurance eligibility and benefits of prospects/referrals and determines LHC rate requirements as it relates to in or out of network coverage on a daily basis in an accurate and timely manner. -Communicates patient benefits in a timely manner using the appropriate legacy system and associated software...

  • Prior Authorization Specialist

    2 weeks ago

    Louisville, United States TEKsystems Full time

    Job DescriptionJob DescriptionDescription:*1-2 month contracted position*- Verifies insurance eligibility and benefits of prospects/referrals and determines rate requirements as it relates to in or out of network coverage on a daily basis in an accurate and timely manner. - Communicates patient benefits in a timely manner using the appropriate legacy system...

  • Admissions Specialist

    5 months ago

    Louisville, United States Acadia Healthcare Full time

    Admissions Specialist Full-TimeVillage Behavioral Health is a psychiatric residential treatment center that offers a full spectrum of treatment options for children and adolescents ages 10-17. A uniqueness about Village Behavioral Health is that we use nature as part of our therapeutic process. We are nestled in Louisville, TN right on the Tennessee River...

  • Pre-Litigation Claims Specialist

    4 weeks ago

    Louisville, Kentucky, United States Isaacs & Isaacs PSC Full time

    Job DescriptionAt Isaacs & Isaacs PSC, we are dedicated to providing exceptional service to our clients. As a Pre-Litigation Paralegal, you will play a critical role in handling personal injury claims from inception to settlement.Key Responsibilities:Enter new files into our case management system and gather relevant information.Analyze intake data and...

  • ENT Precertification Specialist

    4 weeks ago

    Louisville, Kentucky, United States UofL Health Full time

    Precertification Specialist- ENT Job DescriptionUofL Health is seeking a skilled Precertification Specialist- ENT to join our team. The ideal candidate will have a strong background in patient access, insurance verification, and prior authorization.Key Responsibilities:Accurately and efficiently identify all necessary clinical documentation to support...

  • Therapist - Pre-Independent Living Specialist

    1 month ago

    Louisville, Kentucky, United States Boys & Girls Haven Full time

    Job SummaryBoys & Girls Haven is seeking a skilled Therapist to join our team in the Pre-Independent Living program. The ideal candidate will have a Master's degree or higher in a relevant field and at least 2 years of experience working with adolescents and young adults with emotional and behavioral challenges. The Therapist will provide trauma-informed...

  • RN, Pre-Op Unit, PRN

    1 month ago

    Louisville, United States UofL Health Full time

    Overview Job Title: RN, Pre-Op We are Hiring at Mary & Elizabeth HospitalLocation: 1850 Bluegrass Ave. Louisville, KY 40215Shift Options: PRN About UsUofL Health - Mary & Elizabeth Hospital is a 298-bed, full-service hospital which has served generations of patients in south Louisville. Originally founded by the Sisters of Charity of Nazareth in 1874, the...

  • Inventory Management Specialist

    4 weeks ago

    Louisville, Kentucky, United States Three Point Solutions Full time

    Job Title: Inventory Management SpecialistJob Summary: We are seeking a detail-oriented Inventory Management Specialist to join our team at Three Point Solutions. As an Inventory Management Specialist, you will be responsible for ensuring that inventories are secure, properly identified, and readily accessible to authorized personnel.Responsibilities: ...

  • Clinical Operations Specialist

    4 weeks ago

    Louisville, Kentucky, United States Visionworks Full time

    The Clinical Operations Specialist is a key role within Visionworks, responsible for ensuring a seamless patient experience. This involves preparing patients for examinations, completing pre-exam diagnostics tests, and explaining each step of the process in a clear and concise manner.In addition to these responsibilities, the Clinical Operations Specialist...

  • Precertification Specialist- ENT

    3 weeks ago

    Louisville, United States UofL Health Full time

    Overview: We are hiring at UofL Physicians for a Precertification Specialist- ENT Shift: 1st Shift Location:9931 Forest Green Blvd About Us UofL Physicians is one of the largest, multi-specialty physician practices in the Kentuckiana region. With over 700 providers, 200 practice locations and 78 specialties, UofL Physicians academic and community physicians...

  • Precertification Specialist- ENT

    3 weeks ago

    Louisville, United States UofL Health Full time

    Overview: We are hiring at UofL Physicians for a Precertification Specialist- ENT Shift: 1st Shift Location:9931 Forest Green Blvd About Us UofL Physicians is one of the largest, multi-specialty physician practices in the Kentuckiana region. With over 700 providers, 200 practice locations and 78 specialties, UofL Physicians academic and community physicians...

  • Pharmacy Care Coordinator, 8a-4:30p

    3 weeks ago

    Louisville, United States Norton Healthcare Full time

    ResponsibilitiesThe pharmacy care coordinator coordinates all aspects of patient intake and access to high cost, high touch specialty medications, including oral, self-injectable, and clinic-administered. Responsibilities include all necessary benefits investigation/verification (prior authorization/pre-authorization and pre-certification) and required...

  • Pharmacy Care Coordinator, 8a-4:30p

    4 weeks ago

    Louisville, United States Norton Healthcare Full time

    Responsibilities The pharmacy care coordinator coordinates all aspects of patient intake and access to high cost, high touch specialty medications, including oral, self-injectable, and clinic-administered. Responsibilities include all necessary benefits investigation/verification (prior authorization/pre-authorization and pre-certification) and required...

  • Phlebotomy Specialist

    4 weeks ago

    Louisville, Kentucky, United States Baptist Health Full time

    Job Summary:As a Phlebotomy Specialist at Baptist Health, you will be responsible for drawing blood by capillary or venipuncture, labeling tubes properly, and delivering them to the Lab according to Laboratory Policy and Procedure.Maintaining order and organizing workload with phlebotomy staff and other hospital personnel is also a key aspect of this...

  • Electrical Product Specialist

    4 weeks ago

    Louisville, Kentucky, United States Neff Automation Full time

    Electrical Product SpecialistThe Electrical Product Specialist at Neff Automation plays a vital role in designing and bench-testing integrated automation solutions for our customers.As an Electrical Product Specialist, you will be responsible for answering product questions, describing product capabilities, and developing solutions through the design of...

  • Appeals Specialist

    4 weeks ago

    Louisville, Kentucky, United States Alight Solutions Caribe, Inc Full time

    About the RoleWe are seeking an Appeals Specialist to join our team at Alight Solutions Caribe, Inc. As an Appeals Specialist, you will play a critical role in reviewing adverse determinations for Short-Term Disability (STD) and Long-Term Disability (LTD) claims, ensuring compliance with legal and ethical standards.Key ResponsibilitiesManage the...