Pre-Certification Medical Authorization Specialist - Remote ID-1722

• Oversee the managed care in-patient and outpatient referral and pre-authorization process 

• Consult with physicians, nurses, staff, and providers regarding the referral and pre-certification process 

• Maintain referral and authorization records documentation 

• Verify insurance for in-network eligibility and benefits 

• Field calls for prescription benefits questions and prescription verification 

• Contact referring physicians and secure authorizations for treatment 

• Communicate with hospitals to obtain pre-certification numbers 

• Maintain strict confidentiality required related to medical records and other data 

• Participate in professional development opportunities to stay current with health care practices and trends 

• Actively participate in the company’s efforts to create innovative data and analytics solutions for the modern orthopedic business office 

• Other duties as assigned 

Required Skills: 

• High school diploma or equivalent, college courses, or certificate preferred 

• Excellent communication skills, especially phone skills, that encourage the establishment and maintenance of cooperative, positive relationships with both internal and external stakeholders (patients, physicians, colleagues, etc.)  

• Ability to efficiently gather, organize, and comprehend insurance and/ or account information  

• Proficient computer skills with a demonstrated ability to navigate and comprehend computer software systems in an office setting, prefer 50wpm typing skill 

• Knowledge of, or a demonstrated capacity to learn, clinic and insurance contract policies/ procedures and medical terminology 

• Strong analytical skills and a demonstrated desire to be part of building innovative solutions that challenge the status quo 

• Ability to learn quickly and contribute ideas that make the team, processes, and solutions better 

• Share our values: resilience, altruism, communication, achievement, and determination 

Preferred Skills: 

• Two or more years of experience working in pre-certification or managed care 

Work Location:

This is a remote opportunity but must reside in one of the following states: Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Michigan, Missouri, North Carolina, Nevada, Ohio, Oregon, Pennsylvania, Tennessee, or Texas. 

Pre-Certification Medical Authorization Specialist - Remote ID-1722