Prior Authorization​/Workers Compensation Specialist

Prior Authorization/Workers Compensation Specialist

Join to apply for the Prior Authorization/Workers Compensation Specialist role at Orthopedic ONE
.

Responsible for obtaining pre‑certification or authorization information to ensure that practice can be reimbursed for professional or facility fees associated with patient care. Documents information in written or electronic form as needed to ensure efficient workflow.

• Pre‑certification: receive queries for pre‑certification for diagnostic testing, medication, surgery, and physical or occupational therapy, including documentation of ICD‑10 and CPT codes.
• Contact insurance providers to obtain authorization numbers; document inpatient days allowed and send information to appropriate hospital or surgery center.
• Generate pre‑certification/authorization case‑management information in the EMR system and apply data to surgery date of service or appointment.
• Generate reports from EMR to prompt review for changes or cancellations one week prior to procedure.
• Provide phone coverage of the department hotline to support physician offices with same‑day or next‑day requests or questions.
• Referrals: receive referrals and enter information into EMR, including authorization numbers, PCP, visit allotments, expiration dates, and other insurance plan notes.
• Print physician schedules 24–48 hours in advance and review patient information for referrals to ensure correct encounter forms.
• Research missing information by contacting patients, PCPs, or insurance providers.
• BWC: review appointment schedules to identify worker’s compensation patients, retrieve claim information from the BWC website, and create case information in EMR.
• Maintain documentation for worker’s compensation claims (C‑9, MEDCO 14, C‑31, etc.) and communicate with Managed Care Organization case managers as needed.
• Customer service: communicate professionally with patients and insurance carriers, provide solutions, and maintain a pleasant, respectful demeanor.
• Teamwork: volunteer coverage, maintain workflow, collaborate with colleagues, and address conflicts constructively.
• Policies and procedures: comply with Orthopedic One Employee Handbook policies and participate in training and risk management programs.

• High School Diploma or equivalent required;
  Associate’s Degree in Medical Billing and Coding or Health Information Management desirable.
• Minimum of two years of medical billing experience including insurance authorization (prior authorization, pre‑determinations, pre‑certifications) and worker’s compensation.
• Computer skills required to operate practice management systems (Windows, internet, email).
• Ability to work at high volume while maintaining attention to detail and accuracy; excellent oral and written communication skills.

Case Management

Schedule:

Regular Full Time, Day Shift.

Location:

Dublin, OH. Salary: $69,000.00‑$ (dependent on experience).

Employment type:

Full‑time. Seniority level:
Entry level. Job function:
Human Resources. Industry: Hospitals and Health Care.