Clinic Pre-cert Representative

Location: WK Pierremont
Department: Clinic - Spine & Pain Specialist
Classification: Full-Time
Shift: 8:00 AM-5:00 PM
Date Posted: 2/22/2024
Description: The role of the Authorization Specialist is to verify coverage and benefits, obtain authorization as needed, and offer financial counseling for all surgeries and procedures provided by our Practice. The Specialist will also provide assistance to other Insurance Verification & Authorization Specialists as needed.


Essential Qualities The essential qualities necessary include, but are not limited to:
• Patient and pleasant personality; works well with a variety of people • Flexible attitude; adaptable to new challenges and/or projects • Team player • Ability to work independently, with little supervision • Excellent public relations • Interfaces well with staff and physicians • Professional demeanor

Duties and Responsibilities
The Insurance Verification & Authorization Specialist is expected to perform position-related duties that include, but are not limited to:
• Updating of patient insurance information, including memo entry for billing documentation • Contact payers for benefits and eligibility information and to obtain authorization • Customer service - answer inquiries from patients and/or healthcare providers • Determine estimated co-pays/pre-pays for approved services • Assist other personnel as directed by Department Supervisor •Regularly review policy specific medical policies for coverage criteria and limitations •Appeal authorization denials and coordinate Peer to Peer reviews as needed

Job Specifications Education/Experience
• Minimum two years patient account experience • Excellent Communication Skills • Medical Billing office experience is a plus• High School education

Skills/Knowledge/Abilities
• Problem solving skills • Knowledge of medical terminology• Knowledge of CPT and ICD10 coding • Skill in basic data entry; 10-key proficiency • Skill in using a computer • Ability to exhibit cooperation, flexibility, and provide assistance when interfacing with patients, physician and staff •Experience working with Commercial, Medicare, Work Comp, and Attorney payers • Ability to multi-task • Skill in organizing and reporting information that is accurate and complete • Knowledge of basic math skills • Understanding and respecting the need for confidentiality • Ability to maintain composure in stressful situations • Skill in establishing and maintaining effective working relationships with all staff • Ability to prepare records in accordance with detailed instructions • Ability to sit for long periods of time • Ability to communicate effectively in person and on the phone • Consistency and timeliness in attendance

Willis Knighton is an equal opportunity employer and thus, manages its employment and employee relations policies, practices and benefits without regard to age, race, sex, color, creed, religion, national origin, disability, veteran, or other protected status where otherwise qualified.