Precertification Counselor - FSOSM Palm Harbor

Precertification Counselor - FSOSM Palm Harbor at Florida Orthopaedic Institute

Key Responsibilities

• Communicates with patients over the phone in a professional and customer service oriented manner.
• Communicates effectively with staff, secretaries, and physicians by phone or in writing.
• Captures the surgical procedure for assigned physician(s) and becomes the record owner.
• Verifies benefit coverage, eligibility for assigned surgical procedures prior to surgical / procedure date.
• Ensures assigned physician's surgical / procedure pre-certifications, pre-determinations, and pre-surgery deposit collections due are completed in a timely manner.
• Ensures all scheduled surgical procedures, retro authorizations and ER cases are worked timely to ensure all cases are pre-authorized within the allotted timeframe.
• Determines whether the patient's insurance company requires pre-authorization or pre-determination and obtains all authorizations, if applicable.
• Able to identify the differences when a prior authorization or a referral is needed prior to the surgical / procedure date.
• Identifies, reviews, extracts, and provides clinical notes, diagnostic testing results, duration and response to conservative therapy measures from patient's visits to the insurance carrier in an effort to obtain a secure prior authorization for surgical / procedure services.
• Able to utilize medical necessity guidelines for each procedure assigned. Able to recognize missing medical necessity require prior to case submission to insurance company.
• Ensures the nature and outcome of the contact with the insurance carrier of each surgical / procedure requested is documented in specific Florida Orthopaedic Institute programs being utilized within the department to support claims billing and reimbursement of surgical / procedure services.
• Establishes a good working relationship with Primary Care Physician's office, Insurance and the various Hospitals and surgery centers.
• Maintains a thorough understanding of all major insurance carriers benefit verification and authorization processes. Keeps current with updates for various health plans.
• Maintains and utilizes online access to major insurance carriers.
• Ensure all avenues are identified prior to surgical procedure date to ensure all cpt codes are payable with the insurance company.
• Keeps patient, provider, provider assistant and facility educated on the prior authorization status of the pre-authorization of the case in advance.
• Must ensure excellent communication with providers assistant regarding surgical authorization status to prevent reschedule / cancellation of scheduled surgical date.
• Obtains the insurance company's contracted rates.
• Calculates the patient's financial responsibility.
• Collects the patient's pre-surgery deposit.
• Completes and submits all non-payment letters.
• Completes Physician's instructions on non-payment letters.
• Communicates effectively with staff, secretaries, physicians and patients.
• All other duties as assigned

About You

We Would Love It If You Also Had

At FOI our goal is to provide our patients with world-class orthopedic care.

What We Offer

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and / or be subject to random drug testing in accordance with applicable laws and company policy.

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