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Pre-Certification Specialist | Savannah

Job Description:

Optim Healthcare is seeking a full time Pre-Certification Specialist for our Savannah location.

Job Requirements:

  • Reviews patients' medical records for appropriate documentation for the scheduled procedure and accurate insurance as appropriate.
  • Works with medical and other staff in coordinating medical information and patient charts.
  • Responsible for starting and/or completing all pre-certification and benefits for all procedures on the same day the procedure is entered into the pre-certification tool if entered prior to the last hour of the scheduled shift and should follow all ICD-10 requirements by the insurance company.
  • Responsible for monthly follows-up with insurance companies ensuring that coverage is in effect until the procedure is performed.
  • Ensures that all pre-certifications are completed within the designated insurance company turnaround time parameters as required for review and communicates in a timely manner the outcome of these efforts to all appropriate entities.
  • Documents all actions electronically and maintains permanent electronic record in patients' chart and necessary electronic data repositories as required.
  • Completes all necessary actions in the pre-cert tool with dates and times as well as maintaining all other computer systems associated with each procedures - i.e. scheduling systems, SRS, APTA, Group Cast, etc.
  • Answers patient questions and inquiries regarding the pre-certification status of their procedures.
  • Maintains workflow of daily operations with minimal manual paper process to ensure appropriate budgetary guidelines are maintained.
  • Researches and assists the revenue cycle with denial research as it pertains to pre-certification or benefit denials.
  • Maintains strict confidentiality of sensitive information.
  • Performs related work as required.

Optim Offers:

  • Competitive Pay
  • Company Benefits
  • Vacation, Personal Time Off, and Sick Leave
  • Holiday Pay
  • 401K Plan

Apply for this position by sending your resume and cover letter to