Pre-Certification Specialist na Fort Wayne Orthopedics

Build A Career That Matters

Fort Wayne Orthopedics offers a meaningful career that makes a real difference in people’s lives, as well as your own. We provide a professional environment based on respect and dedication to being the best.  Our specialty-trained experts are committed to providing exceptional, compassionate care in the treatment of orthopedic conditions

Pre-Certification

Specialist

This position plays a key role in supporting patient care by obtaining prior authorizations and verifying benefits from insurance payers for services and procedures.  Prior clinical or medical facility/office experience desired.   Knowledge of insurance claims processes, coding and medical terminology beneficial.  Full-time, 8am-5pm, M-F.

Please visit our website at fwortho.com for more information about our providers, services and locations.

Desired Qualifications:

• Prior in healthcare pre-certification, insurance verification, or medical billing.
• Strong knowledge of insurance plans, pre-authorization processes, and healthcare terminology.
• Proficiency with electronic health records (EHR) systems and Microsoft Office applications.
• Excellent communication and organizational skills with attention to detail.
• Familiarity with state and federal healthcare regulations such as HIPAA and Medicare/Medicaid guidelines.
• Advanced skills in data management and reporting tools.
• Demonstrated ability to handle multiple tasks efficiently in a fast-paced environment.

Responsibilities:

• Review patient medical records and treatment plans to determine necessary pre-certification requirements.
• Contact insurance companies to verify patient coverage and obtain pre-authorization for procedures and services.
• Maintain accurate and up-to-date records of all pre-certification requests, approvals, and denials.
• Communicate with healthcare providers and patients regarding the status of pre-certification and any additional information needed.
• Resolve any issues related to insurance denials or delays by coordinating with insurance representatives and clinical staff.
• Ensure compliance with all relevant healthcare regulations, payer policies, and organizational procedures.
• Provide timely updates and reports to management regarding pre-certification activities and challenges.

Skills:

The Pre-Certification Specialist utilizes strong communication skills daily to interact effectively with insurance companies, healthcare providers, and patients, ensuring clear and accurate information exchange. Analytical skills are essential for reviewing medical records and insurance policies to determine coverage and pre-authorization requirements. Organizational skills are applied to manage multiple cases simultaneously, maintain detailed records, and track the status of pre-certification requests. Proficiency with electronic health record systems and software tools supports efficient data entry, retrieval, and reporting, which are critical for compliance and operational transparency. Additionally, problem-solving skills are frequently employed to address and resolve insurance denials or delays, facilitating uninterrupted patient care.