Pre-Authorization Specialist

ONET Systems, LLC is a leading Revenue Cycle Management organization dedicated to providing exceptional service to our clients. We are committed to delivering high-quality services and innovative solutions to our provider and facility practices. As we continue to expand our operations, we are seeking a talented and experienced Pre-Authorization Specialist to join our team in the New York area.

We are currently seeking a highly skilled Pre-Authorization Specialist with a minimum of 1 year of recent experience in handling pre-authorizations for a variety of surgical practices, particularly in orthopedics, pain management, and ambulatory surgical centers. The ideal candidate will have a strong understanding of insurance verification processes, pre-authorization requirements, and medical terminology. The successful candidate will play a critical role in facilitating timely pre-authorizations for patient procedures, ensuring seamless coordination between healthcare providers, insurance companies, and patients.

Responsibilities :

Conduct thorough insurance verification and eligibility checks for patients scheduled for procedures at out-of-network surgical practices.

Collaborate with healthcare providers to gather necessary documentation and medical records for pre-authorization submissions.

Communicate effectively with insurance companies to obtain pre-authorization for orthopedic, pain management, and ambulatory surgical procedures.

Maintain accurate records of pre-authorization requests, eligibility requests, pre-determination requests, approvals, denials, and follow-up actions.

Provide support to patients and healthcare providers regarding pre-authorization status, coverage details, and potential financial responsibilities.

Stay updated on changes in insurance policies, pre-authorization guidelines, and reimbursement processes.

Qualifications :

Minimum of 1 year of recent experience working in pre-authorizations for out-of-network surgical practices, with a focus on orthopedics, pain management, and ambulatory surgical centers.

Strong knowledge of medical terminology, insurance verification processes, pre-determinations and pre-authorization requirements.

Excellent communication skills, both verbal and written, with the ability to effectively interact with healthcare providers, insurance companies, and patients.

Detail-oriented with strong organizational and time management skills.

Ability to work independently and prioritize tasks in a fast-paced environment.

Proficiency in using electronic health records (EHR) systems and insurance verification software.

Certification in medical billing and coding is preferred but not required.

Proficiency in using Excel is preferred but not required.

Experience using Office 365 is preferred.