Pre-Cert Specialist - Fondren

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    "description": "<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Company:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Fondren Orthopedic Group A Division of OrthoLoneStar</span></span></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Title:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Precertification Specialist</span></span></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><b><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Basic Responsibility</span></span></b></span></span></span></p>\r\n\r\n<p class=\"Default\" style=\"text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">The Precertification Specialist is responsible for patient insurance benefits including verification and authorizations. Verifies and analyzes insurance coverage plan for patients upon referral/admission. Communicates plan information to appropriate parties. Provide accurate and complete data input for precertification requests, and ongoing authorizations. </span></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><b><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Specific Responsibilities</span></span></b></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">The specific responsibilities of the Precertification Specialist encompass but are not limited to the following:</span></span></span></span></span></p>\r\n\r\n<ul>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Analyzes and verifies patient insurance coverage and determines payer priority for all potential insurance and private pay coverage</span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Obtains prior insurance authorization</span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Reviews requests made by physicians and other authorized medical staff for additional authorized units under established guidelines</span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Initiates prior and post authorization requests via fax transmission, online submission and/or telephone contact</span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Returns calls back to insurance providers with precertification numbers as needed and file completed precertification requests as per established protocols</span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Ensures that all prior authorizations and ongoing authorizations documentation, databases and records are maintained clearly, accurately within a timely manner, and meets HIPAA requirements</span></span></span></span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"text-align:justify\">&nbsp;</p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Skills Required:</span></span></span></span></span></p>\r\n\r\n<ul>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Working knowledge of insurances for authorization and appeals requirements</span></span></span></span></li>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Knowledge of Microsoft Office applications which may include Outlook, Word, and Excel</span></span></span></span></li>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Excellent customer service and professionalism to resolve complex payer coverage issues</span></span></span></span></li>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Good knowledge of general office practices and procedures</span></span></span></span></li>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Excellent organizational and analytical skills</span></span></span></span></li>\r\n\t<li class=\"Default\" style=\"margin-left:8px; text-align:justify\"><span style=\"font-size:12pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\"><span style=\"color:black\"><span style=\"font-size:11.5pt\">Excellent oral and written communication skills, strong interpersonal skills, and ability to work in an autonomous and independent manner</span></span></span></span></li>\r\n\t<li style=\"text-align:justify; margin-left:8px\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Knowledge of HIPAA requirements</span></span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"text-align:justify; margin-left:48px\">&nbsp;</p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Minimum education and work experience requirement:</span></span></span></span></span></p>\r\n\r\n<ul>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">High school diploma. </span></span></span></span></span></span></span></li>\r\n\t<li style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"color:black\"><span style=\"line-height:normal\"><span style=\"text-autospace:none\"><span style=\"font-family:Calibri,sans-serif\"><span style=\"font-size:11.5pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Prior experience with billing processes, prior authorizations, billing systems, knowledge of different insurance plans and ability to research complex issues. </span></span></span></span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:11pt\"><span style=\"line-height:normal\"><span style=\"font-family:Calibri,sans-serif\"><b><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">Reports to:</span></span></b><span style=\"font-size:12.0pt\"><span style=\"font-family:&quot;Times New Roman&quot;,serif\">&nbsp;&nbsp;&nbsp;&nbsp; Pre-Cert Supervisor</span></span></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\">&nbsp;</p>\r\n\r\n<p style=\"text-align:justify\">&nbsp;</p>\r\n",
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