Surgery Pre-Cert Coordinator

JOB SUMMARY: Responsible for reviewing surgery orders that are awaiting authorization, verifying insurance benefits and obtaining authorization. Composing surgical estimates, Good Faith Estimates, and reviewing them with the patient as needed. Following documentation guidelines and communicating with the surgical team and management.

EDUCATIONAL REQUIREMENTS:

• High school diploma required
• Advanced Degree or Certification preferred

QUALIFICATIONS AND EXPERIENCE:

• Three plus years of work experience in a physician practice required
• Pre-Certification experience is preferred
• Knowledge of practice management and electronic health record software
• Ability to perform multiple and diverse tasks simultaneously
• Strong written and verbal communication skills
• Strong attention to detail and problem solving skills

Responsibilities include, but are not limited to, the following:

• Review surgery order list for surgeries that are awaiting authorization. Prioritize as needed.
• Verify insurance benefits via insurance portals when applicable. When not applicable, verify insurance benefits via phone.
• Obtain authorization for surgical procedures via insurance portals when applicable. When not applicable phone in the authorization request or fax as needed.
• Review progress notes and articulate medical necessity information to insurance carriers as needed.
• Send all requested medical records needed to assist in the authorization process.
• Follow up on pending surgical procedures within two business days to ensure the insurance company has received the authorization request (when applicable).
• Compose surgical estimates and Good Faith Estimates; review them with the patient as needed.
• Ensure the surgery authorization notes area is updated at all times.
• Communicate with Physician Teams pending authorizations (within two business days), benefit limitations, etc.
• Address all surgery recertification requests from the surgery coding specialist.

General Administration

• Maintain detailed knowledge of practice management, electronic health record and other computer software as it relates to job functions.

• Attend continuing education courses as requested.
• Complete all other duties as assigned by the Physician Team Manager.
• Notify Physician Team Manager of all surgery re-certifications.
• Abide by HIPAA Confidentiality Agreement.

Supervisory Responsibilities
This job has supervisory responsibilities.

Typical Physical Demands
Position requires extended sitting, some standing, bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Employee will work under stressful conditions, and work irregular hours.

Typical Working Conditions
Normal office environment. Occasional evening or weekend work.

Job Type: Full-time