Overview
Pre-Authorization Specialist Jobs in Laramie, WY at Premier Bone & Joint Centers
Title: Pre-Authorization Specialist
Company: Premier Bone & Joint Centers
Location: Laramie, WY
Job Summary:
Perform insurance pre-certification duties for surgical procedures, MRI scans, and injections. Make payment arrangements for estimated patient responsibility for surgical procedures, MRI scans, and injections per policy; provide excellent patient services via telephone and in person.
Essential Duties & Responsibilities:
Correct Insurance Company
- Obtain correct insurance company information such as Workers' Compensation vs. commercial insurance, including telephone number and policy numbers from system.
Pre-Certification/Pre-Authorization
- Contact insurance companies to obtain pre-certification for all outpatient surgical procedures, inpatient surgical procedures, short-stays, MRI and CT scans, and injections, if required by the insurance plan.
Insurance Benefits
- Obtain insurance benefit information and calculate pre-surgical payments for all surgical procedures performed at all locations and for all MRIs perfomed at Premier Bone and Joint Centers' locations.
Contact Patient
- Contact patients regarding estimated patient responsibility amounts for all surgical procedures, MRIs, and injections scheduled at all Premier Bone & Joint Centers' locations, review all outstanding balances with patients, and design payment arrangements if necessary.
Surgical Charts
- Assemble ASC surgical charts and deliver the charts to the front desk the day before the scheduled surgical procedure.
Pre-Payment Information
- Provide pre-payment information to the front desk staff.
Insurance Carrier Tools
- Use insurance carrier tools to estimate patient out-of-pocket costs.
Insurance Contractual Discounts
- Knowledge of insurance contractual discounts.
Insurance Provider Policy Knowledge
- Knowledge of insurance provider policies and procedures regarding patient claims.
Medical Terminology Knowledge
- Knowledge of medical terminology and basic human anatomy.
Interpersonal Skills:
Working Relationships
- Ability to establish and maintain effective working relationships with physicians, co-workers and the public that harbor a friendly, yet professional interaction. Demonstrate willingness to readily interact with other staff members and department.
Mentor
- Acts as a mentor for new employees.
Personal Growth
- Accepts responsibility for own professional growth and personal conduct by seeking knowledge in work specific areas, taking advantage of opportunities at work to observe and volunteer.
Flexibility and Stressful Situations
- Ablility to be flexible, organized, and function under stressful situations.
Adherence to Facility/Departmental Policy:
Confidentiality
- Observe confidentiality of information in regards to patients, physicians, and fellow employees; ability to maintain confidentiality under HIPAA standards.
Attendance/Punctuality
- Maintains a good attendance record and arrives to work punctually.
Overtime
- Able to substantiate overtime, minimizes overtime and adjusts hours as needed.
Dress Code/Identification
- Follow dress code of the department, appear professional when present in the clinic, wear identification while on duty, and communicate name and role to patient appropriately.
Cell Phone Use
- Cell phone may be used for business purposes only. Utilizes cell phone for personal use only during breaks or meal periods out of the public eye.
Staff Meetings/In-services
- Participates in Premier Bone & Joint Centers and departmental in-services and staff meetings.
Safety & Infection Control Policies
- Adhere to safety and infection control policies.
Care of Environment, Equipment, and Supplies:
Clean, Neat, Safe Environment
- Maintain a clean, neat, and safe environment for patients and staff, including personal work areas.
Office Equipment Skills/Malfunctioning Equipment
- Utilizing correct/safe technique when using equipment and notify manager of malfunctioning equipment.
Requirements
Education:
- High School Diploma or Equivalent General Required
Experience:
1 Year – Business Office Type Experience – Preferred
Physical Requirements:
Seeing – Must be able to read reports and use a computer – Constant
Hearing – Must be able to hear well enough to communicate with patients, physicians, administrative staff, insurance companies, and co-workers – Constant
Speaking- Must be able to verbally communicate with patients, physicians, administrative staff, insurance companies, and co-workers – Constant
Grasping – Must be able to write and type – Constant
Standing – Rarely
Sitting – Frequently
Weight Demands:
Lifting – Must be able to lift 10 pounds or less – Occasionally
Working Conditions:
Environmental Hazards
- The fast paced environment may lead to increased levels of personal stress and demand high mental acuity.
Physical Hazards
- Physical harm is possible when performing physical requirements, as listed above.
- Exposure to communicable disease, bodily fluids, and/or toxic substances is possible and can be physically harmful.
Unique Work Schedule/Travel
- May be required to work after hours, on weekends, or holidays.
- May be required to provide services outside the clinical setting (i.e. at University or High School athletic events), or travel to offices throughout the state.
