Member Certification Manager jobs in Chattanooga, TN

SEES is looking for an Retina Pre-certification Representative to join our Chattanooga team!

SEES Group operates multi-specialty medical practices and ambulatory surgery centers across the Southeastern United States and US Territories. Working with community-based Optometrists and Physicians, we provide patients with the highest quality medical and surgical eye care they need close to home. Our organization’s shared values include integrity, respect, service, compassion, and excellence!

SEES Group recognizes that our employees are our most important asset. Because of this, we strive continuously to encourage our staff to live their healthiest life by providing benefits, perks, resources, and programs to assist with managing both their physical and mental health. We offer access to an employee assistance program for those who may need mental health, legal, or financial assistance. Also, we are currently offering a quarterly “Stress Free Day” to full time staff members where employees can take a paid day off to focus on their own wellness and mental health.

Aside from those fantastic benefits, we also offer medical, dental, and vision insurance; 7 paid holidays; employer paid life Insurance; a robust paid-time allotment; voluntary products such as short and long term disability coverage; and a 401k retirement plan with a generous employer match. We offer certification programs to clinical staff to assist in professional development. Lastly, we offer employee service awards to our tenured staff members to recognize our appreciation for their continued service to our organization.

POSITION SUMMARY

The Retina Pre-certification Representative responsible for conducting preregistration and account management.. The primary duties include but are not limited to verifying patient insurance eligibility and coverage, obtain referrals for patient procedures and office visits, and communicating with all parties to include patient and staff.

ESSENTIAL FUNCTIONS include the following:

• Answers patient questions regarding their insurance coverage & account balance.
• Verifies insurance eligibility. Ensures accurate admission data and patient information is correctly entered into the EHR system
• Ensures necessary referral and referral documentation is appropriately loaded to patient account, as well as a copy in the patients chart pre-arrival. Request referrals from PCOs if not received.
• Determine patient portion of copays, co-insurance and/or deductibles prior to patients appointment and communicates this by adding AR note to patient account.
• Manages the flow of information between the online patient portal and the EHR system
• Monitors and follows up on patient account balances, provides info regarding appropriate payment arrangements, provides front desk with info pre-arrival.
• May process and post payments to patient accounts.
• Cross coverage with Patient Services Receptionist.
• Obtain all prior-authorizations for all retina injection patients
• Handle all appeals for Prior-authorizations
• Obtain all surgery pre-certifications for all retina surgeries
• Obtain all referrals for retina patients
• Verify all insurance changes for all retina injection patients
• Collect and distribute and review all mail from the mail room for Chattanooga Retina Division
• Maintains confidentiality of patient and company information
• Demonstrates excellent customer service skills for both internal and external contacts
• Reacts productively to change

KNOWLEDGE, SKILLS, & ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Good problem solving and analytical skills
• Detail oriented with strong organizational and follow-up skills
• Good interpersonal and customer service skills
• Good computer skills including use of standard office programs
• Familiarity with insurance eligibility verification, precertification, deductibles, and coinsurance
• Ability to adapt to changing insurance regulations
• Ability to speak, read, and write in English
• Ability to effectively communicate both orally and in writing
• Ability to operate standard office equipment
• Ability to concentrate, think, and learn
• Ability to hear, see, sit, stoop, kneel, crouch, reach, and handle

EDUCATION AND/OR EXPERIENCE

High School diploma or equivalent is required; a minimum of one (1) year experience in medical insurance or billing is preferred; medical insurance knowledge is required; and/or equivalent education or experience in job related activities is required.