Pre-certification Specialist - Pain Management

Southwoods Health Youngstown, Ohio
pain management management insurance health pain management management medical surgery procedures report investigating referrals calls
Pre-certification Specialist - Pain Management

Southwoods Health is currently hiring a Pre-certification Specialist in our Pain and Spine Center in Boardman, Ohio. This person will work with various insurance companies and referring physician offices to obtain insurance pre-certification for pain management procedures ordered.

  • Respond promptly to referral source requests for information, supporting documentation, or other report needs
  • Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
  • Obtain authorization from payer sources to begin services
  • Answer and screen telephone referrals
  • Handle incoming calls for department and schedule patients as needed
  • Assist in resolving insurance issues, re-authorization and eligibility issues
  • Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements
  • Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed
  • Facilitate follow-up regarding ongoing services, eligibility and authorization
  • Communicate payer verification or benefit issues
  • Record insurance information to maintain data and communicate insurance information to pertinent staff
  • Maintain confidentiality of patient information
  • Independently maintain and work from the electronic medical record and additional databases
  • Obtain pre-certification number from physician s office if applicable
  • Maintain current list of facility insurance contracts
  • Assist in the development, organization, and maintenance of role specific documents, policies, and tools
  • Follow all federal, state, and regulatory guidelines to maintain compliance

  • Training or courses in business office activities
  • Good typing skills
  • Good communication skills
  • Good computer skills
  • Strong ethical and moral character references
  • Insurance verification experience
  • Minimum of 2 years experience pre-authorizing medical imaging exams across modality and specialty (FP or IM office experience a plus)

Work Site Highlights:
Founded in 1996, Southwoods Health has grown from a physician owned Ambulatory Surgery Center with four operating rooms to a multi-service, physician owned health system. The Surgical Hospital at Southwoods is an acute care hospital renowned for providing a superior patient experience and consistently ranking at the top of national patient satisfaction and quality of care surveys. The hospital continues to expand its scope of services, which includes inpatient, outpatient and robotic-assisted surgery, as well as endoscopy services. Southwoods offers a provider network comprised of hundreds of physicians and advanced practice providers, as well as an expanding array of ancillary health services at locations across Mahoning, Trumbull and Columbiana Counties all of which are certified to meet Southwoods high operational standards.
Full-time, Monday-Friday 8am-4:30pm. This is an opportunity to join one of Ohio's most rapidly expanding healthcare organizations.

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