Onet-Systems
ONET Systems is a leading Revenue Cycle Management (RCM) 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.
We are currently seeking a Pre-Authorization Specialist with a minimum of 1 -3 years 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 1-3 years 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 Microsoft 365 Office Suite
We are currently seeking a Pre-Authorization Specialist with a minimum of 1 -3 years 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 1-3 years 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 Microsoft 365 Office Suite