Job detail

UR Pre-certification and Denials Specialist- Hybrid Schedule

OrthoCarolina

#Documentation #EMR #Surgery #Therapy #MRI #DME #Radiology #Appeals #Authorization Process #Claim Denials

Quick overview

The UR Pre-Certification Specialist is responsible for receiving all OrthoCarolina claim denials for services not authorized. This role requires familiarity with EMR and investigating documentation for all departments.

Requirements summary

The candidate must understand the authorization process, medical criteria, denials, and appeals. Knowledge of claims processing and the ability to verify eligibility and benefits is essential.

Insurance VerificationClaims ProcessingAuthorizationsMedical KnowledgeInsurance Eligibility VerificationInsurance AuthorizationsHealth Insurance VerificationMedical Billing and Coding

Job description

At OrthoCarolina, our team is our greatest asset and the foundation of our success.
We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization.
OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better.
Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement.
To learn more about Team OC please visit https://www.orthocarolina.com/about-us 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.
The UR Pre-Certification Specialist- Hospital Pickup and Denials is responsible for receiving all OrthoCarolina claim denials for services not authorized for Therapy, MRI, Radiology, Surgery, Physiatry, DME, Hospital E&M, and high dollar injections.
This role is required to be familiar with all areas of EMR (clinical, UR, transactions) and investigating documentation for all departments.
Essential Functions: Completely understanding the authorization process, medical criteria, denials, and appeals and will serve as a liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized.
Must have knowledge of claims processing as well as the ability to verify eligibility and benefits and obtain any required authorization for all UR Departments.
Employee Type Regular Qualifications Skills Authorizations, Claims Processing, Health Insurance Verification, Insurance Authorizations, Insurance Eligibility Verification, Insurance Verification, Medical Billing and Coding, Medical Knowledge Education Certifications Language Work Experience Our growth is creating great opportunities!
As our organization continues to grow we're opening new opportunities for talented people like you.
Explore our current openings and apply to the roles that inspire you.
Once you apply, you can easily track your progress and stay updated on new positions that match your interests.
Thanks for your interest in working on our team---your next great career move could start here!

UR Pre-certification and Denials Specialist- Hybrid Schedule

Quick overview

Requirements summary

Job description

Benefits

More openings at OrthoCarolina

More district openings

Similar live jobs