OrthoCarolina
UR Pre-Certification Specialist- Hospital Pickup and Denials (Hybrid Schedule)
OrthoCarolina, Charlotte, North Carolina, United States, 28245
Overview
OrthoCarolina is looking for a UR Pre-Certification Specialist- Hospital Pickup and Denials for our OrthoCarolina Business Office location in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs.
Responsibilities
Receive all OrthoCarolina claim denials for services not authorized, including Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high-dollar injections; investigate documentation and coordinate with related departments.
Understand the authorization process, medical criteria, denials, and appeals; serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to unauthorized services.
Verify eligibility and benefits and obtain required authorization for all UR Departments.
Education/Experience
Associates degree preferred, but not required
Two years of experience in medical pre-certification and pre-collection
Experience in utilizing insurance websites for verifying eligibility, benefits and obtaining pre-certification
Qualifications
Authorizations, Claims Processing, Health Insurance Verification, Insurance Authorizations, Insurance Eligibility Verification, Insurance Verification, Medical Billing and Coding, Medical Knowledge
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Responsibilities
Receive all OrthoCarolina claim denials for services not authorized, including Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high-dollar injections; investigate documentation and coordinate with related departments.
Understand the authorization process, medical criteria, denials, and appeals; serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to unauthorized services.
Verify eligibility and benefits and obtain required authorization for all UR Departments.
Education/Experience
Associates degree preferred, but not required
Two years of experience in medical pre-certification and pre-collection
Experience in utilizing insurance websites for verifying eligibility, benefits and obtaining pre-certification
Qualifications
Authorizations, Claims Processing, Health Insurance Verification, Insurance Authorizations, Insurance Eligibility Verification, Insurance Verification, Medical Billing and Coding, Medical Knowledge
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