Precertification Coordinator

Midwest Orthopaedics At Rush - Westchester, IL

Full-time - Entry Level

Remote - Westchester, IL

Ambulatory Health Care Services

About the position

The Precertification Coordinator at Midwest Orthopaedics at RUSH is responsible for obtaining prior approval and authorization from insurance companies for various medical services. This full-time position offers a work-from-home opportunity, requiring flexibility to come into the office as needed. The role emphasizes excellent customer service, strong communication skills, and proficiency in computer systems to manage insurance verification and precertification processes effectively.

Responsibilities

• Obtain prior approval/precertification from patient insurance companies for surgical, MRI, PT/OT, DME, and other services.
• Verify patient insurance information utilizing the RealMed system.
• Obtain prior approval for services via telephone, facsimile, or internet.
• Verify in-network and out-of-network coverage levels for services.
• Coordinate services with hospitals for out-of-network protocols.
• Refer patients with out-of-network coverage to the Financial Coordinator for payment options.
• Coordinate all documentation required for precertification of services, including medical records and pre-operative reports.
• Request assistance from managers or physician offices for additional clinical information as needed.
• Notify physician offices and/or patients when services are not approved.
• Understand the process and protocols for appealing precertification decisions.
• Keep records of phone calls, noting contact names, phone numbers, and reference numbers.
• Contact insurance companies and third-party administrators in a timely manner.
• Organize and prioritize workflow based on the needs of each physician office.
• Respond promptly to requests from physicians, physician secretaries, and other staff.
• Utilize professional telephone conduct at all times.
• Stay compliant with all state and federal laws including HIPAA, ADA, OSHA, and FLSA.
• Answer patients' questions regarding statements and insurance coverage.

Requirements

• High school diploma or GED.
• Minimum of one year work experience, preferably in a medical office setting.
• Excellent customer service skills.
• Strong communication skills, both verbal and written.
• Proficiency in computer skills.

Benefits

• Comprehensive compensation and benefits package
• Opportunities for career growth and development