Member Certification Specialist jobs in Gary, IN

Job Description

As the region's dedicated experts in exceptional musculoskeletal care, our doctors and staff at Lakeshore Bone & Joint Institute have served the orthopedic needs of Northwest Indiana since 1968. With state-of-the-art facilities, we are dedicated to delivering the exceptional, compassionate care that our patients need to keep moving and keep enjoying their life.

The Pre-Certification and Scheduling Specialist is responsible for the following tasks:

Precertification/Prior Authorization & Scheduling:

o MRI
o PT/DME
o Surgery
o In Office Injections

The Pre-Certification and Scheduling Specialist is responsible for completing the pre-authorization and scheduling process for MRI and surgery. The Precertification and Scheduling Specialist is expected to provide the highest level of service to patients, fellow employees, and outside sources through ensuring that insurance benefits and pre-certification is complete, accurate, timely, and fully documented. Manual dexterity is required and the ability to concentrate on detail amid other activity. Must follow have the capacity to specific protocols in scheduling and in the collection of insurance information. 

Essential Functions:

• Obtain authorization via payer website or by phone and follow up regularly on pending cases.
• Prioritize incoming authorization requests according to urgency.
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
• Initiate appeals for denied authorizations.
• Schedule and coordinate patient surgeries and MRI’s.
• Communicate with surgical facilities and send all necessary surgical forms.
• Review surgery schedule with facilities the day before surgery; create and send email to physicians.
• Meet deadlines as determined by the date of procedure.
• Respond to clinic questions regarding payer medical policy guidelines.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
• Contact patients to discuss authorization status.
• Document all work in practice management system.
• Other duties as assigned.

• Strong attention to details.
• Time Management, prioritization, and sense of urgency.
• Basic understanding of insurance rules and regulations.
• CPT/ICD10 knowledge.
• Medical terminology.
• HIPAA compliance.

Work is performed in an office environment. Involves frequent contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive. It is possible work may involve interaction with injured and/or sick patients. 

Role Qualifications:

• Must be at least 18 years of age.
• Must have reliable transportation.
• Proficiency in Microsoft Word, Excel and Outlook preferred.
• Digital literacy.

• Work experience in a medical office setting preferred but will train the right candidate.
• Healthcare related background including surgical terminology preferred.
• Scheduling and pre-authorization experience preferred.

High school diploma or the equivalent.

Required Skills: 

• Critical thinking and problem solving.
• Maintains composure and operates with emotional intelligence.
• Strong attention to detail.
• Receptive to and responsive to feedback.
• Excellent verbal and written communication skills.
• Time management, prioritization, and sense of urgency.

While performing the duties of this job, the employee may be required to sit and/or stand for prolonged periods, work longer than eight (8) hour shifts, and to work both day/evening shifts.  Work may require hand dexterity as well as the need to reach, climb, balance, stoop, kneel, crouch, talk, and hear.  While performing the responsibilities of the job, the employee is required to talk and hear. Specific vision abilities required by the job include close vision and the ability to focus. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the job.

Compliance:

All employees have a responsibility to comply with our organization’s policies and procedures, adhere to our Code of Conduct, complete required compliance training modules, and report any observations of non-compliance.

EEO Statement:

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.