Pre Certification Specialist

Job Location: Minneapolis with potential to work from home
Job Status: Full-Time, Monday – Friday 8:00 – 4:30pm
Job Summary:
Join Twin Cities Spine Center’s family-like culture, where we all contribute to creating and maintain an atmosphere of teamwork and collaboration. The Pre Certification Specialist will collaborate with many departments to ensure a smooth verification process for our patients. The Pre Certification Specialist’s primary role is to understand and apply various health insurance providers’ surgical preauthorization policies and procedures to facilitate a streamlined authorization process for our patients’ surgical procedures. The primary responsibilities include obtaining required prior authorization/notification from insurance company, providing answers to patients’ questions/concerns regarding health insurance coverage and prior authorization criteria as well as communicating with the patients’ health insurance provider and their physician teams. The Pre Certification Specialist’s strives to minimize authorization approval time, improving customer satisfaction as it relates to timeliness of pending services and communication of patient obligations. Candidates should have a passion for continuous learning and change as well as recent experience working with various health insurance companies with an in-depth knowledge of their protocols/policies.
Job Responsibilities:

• Collects and organizes patient records, submits online/electronic documents, and makes outbound calls to obtain necessary insurance pre-authorizations or pre-certifications prior to the patient surgery and documents all information in the patient record
• Works closely with each team and department to manage the patient surgical authorization process
• Effectively communicates prior authorization process progression to patients and physician team
• Provides patients assistance with questions and concerns regarding health insurance coverage and prior authorization criteria
• Obtains additional pre-certification coverage when required and/or informs all parties of denial or loss of insurance coverage
• Uses online, web based verification systems to ensure accuracy and to expedite prior authorization process
• Contacts insurance companies to ensure patient eligibility
• Ensures that procedures meet all insurance medical necessity coverage requirements
• Monitors utilization of resources to insure all services are covered and meet insurance pre-certification coverage guidelines
• Works closely with providers and patients to resolve denials and appeals
• Acts as the liaison for the patient and their TC Spine physician, business office, Primary Care Provider and Health Insurance provider
• Completes insurance pre-certification prior to the patient surgery and documents all information in the patient record
• Continually stays updated with new insurance policies/procedures
• Review monthly/quarterly newsletters from insurance companies to verify any upcoming changes
• Works closely with insurance company vendors to ensure department is aware of changing prior authorizations and new policies/procedures
• Research, identify, and learn new websites with no direction from insurance companies
• Ensures authorizations are updated as DOS changes
• Fosters close relationships with utilization nurses at insurance companies
• Displays professionalism, compassion, tact, and respect at all times when working with co-workers and patients
• Maintains strict confidentiality and adherence to all laws and regulations applicable to the position, including HIPAA
• Other duties and responsibilities as assigned

Job Requirements and Competencies:

• 2-3 years recent insurance/business office experience; prior authorization experience required
• In depth knowledge of various insurance companies and their surgical protocols/policies
• Medical terminology, spine anatomy background; preferably orthopedic
• Minimum of a High School Diploma
• Proficiency in MS Office Suite
• Computer and software experience including the use of Electronic Medical Records (EMR), NextGen preferred
• Strong attention to detail and thoroughness
• Strong written and verbal communication skills
• Ability to work in a fast paced environment and meet established deadlines with a sense of urgency
• Skilled at organizing and prioritizing workload and following assignments through to completion
• Ability to be flexible in schedule and adaptable to constant change
• Ability to effectively handle and prioritize multiple tasks, frequent interruptions, and details with accuracy
• Ability to maintain regular attendance and on-time arrival to work as scheduled
• Ability to deliver high quality customer service to external and internal customers by communicating with knowledge and compassion
• Ability to work with patients of all ages, ethnicities, and backgrounds
• Ability to perform in a high-pressure environment
• Active Listener - Giving full attention to conversations, asking appropriate questions, comprehending the points being made and using great judgment in all situations

The above job description is intended to provide a general outline of some of the basic job requirements and responsibilities and is not all inclusive. Job responsibilities, required skills, and working conditions are also subject to change from time to time.
Twin Cities Spine Center is an Equal Employment Opportunity Employer, and provides reasonable accommodation to qualified disabled individuals in accordance with applicable federal and state law.

Job Type: Full-time