"Alerted.org

As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care patients need to keep moving and keep enjoying their life.

The Pre-Certification Specialist – Spine is responsible for the following tasks:

Verification of Benefits for all Spine surgeries and Precertification of all Spine Surgeries.

The Pre-Certification Specialist is responsible for completing the pre-authorization process for spine surgeries. The Pre-Certification Specialist is expected to provide the highest level of service to patients, fellow employees, and outside sources through ensuring that insurance benefits and pre-certification is complete, accurate, timely and fully documented. Manual dexterity is required and the ability to concentrate on detail amid other activities. Must have the capacity to follow specific protocols in the collection of insurance information.

Essential Functions:

+ Obtain authorization via payer website or by phone and follow up regularly on pending cases

+ Prioritize incoming authorization requests according to urgency

+ Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations

+ Initiate appeals for denied authorizations

+ Communicate with surgical facilities and send all necessary surgical forms

+ Meet deadlines as determined by the date of procedure

+ Respond to clinic questions regarding payer medical policy guidelines

+ Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order

+ Contact patients to discuss authorization status

+ Document all work in practice management system

+ Other duties as assigned

Competencies:

+ Strong attention to details

+ Time Management, prioritization and sense of urgency

+ Basic understanding of insurance rules and regulations

+ CPT/ICD10 knowledge

+ Medical Terminology

+ HIPAA Compliance

Preferred Experience:

1 year of pre-certification experience preferred, medical terminology, CPT and ICD 10 knowledge.

Minimum Education:

High school diploma or the equivalent

Physical Requirements

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts. Work may hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear. The employee must occasionally lift and/or move up to 50 lbs. While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus. Reasonable accommodation can be provided to enable people with disabilities to perform the essential functions described of the job.

Environmental/Working Conditions

Work is performed in an office environment. Involves frequent personal and telephone contact with patients and with testing sites and surgery departments. Work may be stressful at times. Interaction with others is constant and interruptive. Contact involves dealing with injured sick people.

Compliance

All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete the required compliance training modules, and report any observations of non-compliance.

EEO Statement

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.