POSITION SUMMARY: The Pre-Certification & Insurance Specialist is responsible for verifying patient insurance eligibility and benefits, obtaining prior authorizations, and coordinating pre-certification requirements for scheduled procedures. This position provides patients with procedure estimates, explains financial responsibilities, collects pre-payments when appropriate, and serves as a resource for insurance and billing questions. Success in this role requires exceptional attention to detail, strong communication skills, and a commitment to providing an excellent patient experience. WHAT WE OFFER: • Starting wage of $16 - $19 per hour based on previous experience • 6.5 paid holidays per year + 2 floating holidays • Approximately 8 days of PTO within first year • Full slate of benefits to include health, dental, vision, and 401k • Growth and wage increase through company paid certification program ESSENTIAL RESPONSIBILITIES: • Monitor scheduled surgeries and maintain organized list with status of pre-certification process. • Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information in Eyecare as required. • Check insurance payment policy for scheduled procedures and obtain prior authorization when required. • Verify receipt of all necessary pre-authorization documents prior to procedure. • Communicate effectively with the facility in which the procedure will be performed as needed. • Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips. • Notify primary care physician for managed care plans that require PCP authorization. • Supply patients with written or verbal estimates of surgical codes and fees upon request. • Meet with patients pre-operatively or communicate effectively as necessary with patients so they understand the billing process and their financial expectations pre-operatively. • Collect pre-payment from the patient when necessary. • Notify patients with past due accounts of pre-payment policy for elective surgery. Receive payments from patients. • Assist with check-in and check-out when needed. Serve as a resource on insurance, billing and customer service for reception and cashier. • Monitor cash box and report balance to supervisor and accounting department monthly. • Perform other duties or functions as assigned. EDUCATION AND/OR EXPERIENCE: • A minimum of two (2) year's experience in the medical field. • Must have a strong knowledge of anatomy, physiology, medical terminology, and medical insurance. PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA guidelines): • Physical Activity: Talking, Hearing, Repetitive motion. • Physical Requirements: Sedentary work. Involves sitting most of the time. • The worker is required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.