ONET Systems is a leading Revenue Cycle Management (RCM) organization dedicated to delivering high?quality services and innovative solutions to provider and facility practices. We are currently seeking a Pre?Authorization Specialist with 13 years of recent experience handling pre?authorizations for various surgical practices, particularly 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 and 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 13 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 Salary: $20 $24 per hour Seniority level Entry level Employment type Full?time Job function Other Industries Hospitals and Health Care #J-18808-Ljbffr
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