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JOB TITLE: Pre-certification Specialist
GENERAL SUMMARY OF DUTIES: Pre-certs all surgeries prior to day of surgery and follows up with insurance companies if diagnosis or procedures changed. Must be familiar with ICD-9 and CPT code books.
SUPERVISION RECEIVED: Reports directly to the Surgery Center Supervisor
SUPERVISION EXERCISED: None
TYPICAL PHYSICAL DEMANDS: Work may require sitting for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, type, operate a calculator, telephone, copier and other such office equipment as necessary. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. It is necessary to view and type on computer screens for long periods and to work in an environment which can be very stressful.
TYPICAL WORKING CONDITIONS: Work is performed in an office environment. Involves frequent contact with staff, patients, insurance company representatives and the public. Work may be stressful at times. Contact may involve dealing with angry or upset people.
DUTIES: (This list may not include all of the duties assigned).
- Reviews patients’ medical records
- Works with medical and other staff in coordinating medical information and patient charts
- Responsible for pre-certing all surgeries, if required by ICD-9 code with the appropriate insurance company
- Follows-up with insurance companies ensuring that coverage is in effect
- Documents all actions and maintains permanent record in patients’ chart
- Answers patient questions and inquiries regarding the precert status of their surgeries
- Maintains strict confidentiality of sensitive information
- Performs related work as required
PERFORMANCE REQUIREMENTS:
Knowledge, Skills & Abilities:
Knowledge of medical terminology. Knowledge of grammar, spelling, and punctuation to type correspondence. Knowledge of insurance industry. Skill in operating a computer and photocopy machine. Ability to read, understand, and follow oral and written instruction. Ability to maintain confidentiality of sensitive information. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees, and the public.
EDUCATION: 1. High School Diploma or GED
2. Successful completion of a course in Medical Terminology
EXPERIENCE: 1. Minimum of one year experience in a Medical Office
2. Computer Experience
CERTIFICATE/LICENSE: None
ALTERNATIVE TO MINIMUM QUALIFICATIONS:
Additional appropriate education may be substituted for experience.
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