PRECERTIFICATION SPECIALIST (11556)

Precertification Specialist

Location(s): Jeffersonville
Department: Precertification
Job Type: Full Time, Non-Exempt
Schedule: Monday through Friday- In Office (Day Shift)

Reports to: Precertification Manager

First Urology is the largest independent urology practice serving Louisville, Kentucky, and Southern Indiana, providing comprehensive care for men, women, and children across multiple locations. Our team is dedicated to delivering exceptional patient care through advanced technology, innovative treatments, and a collaborative approach that puts patients first. We offer a full spectrum of urologic services, including minimally invasive surgery, cancer care, men's and women's health, kidney stone treatment, pelvic health, imaging, pathology, clinical research, and more.

At First Urology, our people are the heart of everything we do. We foster a culture built on teamwork, respect, integrity, and continuous growth, where employees are empowered to make a meaningful impact on the lives of our patients and one another. Our commitment to investing in our team has earned us recognition as one of Business First's Best Places to Work in Louisville and Southern Indiana for 10 consecutive years, along with additional workplace honors. We offer competitive compensation, generous benefits, opportunities for professional development, and a healthy work-life balance.

If you're looking to join an organization that values excellence, innovation, compassion, and community, First Urology is a place where your career can thrive while making a difference every day. Learn more at www.1sturology.com or follow us on Facebook, Instagram, and LinkedIn.

Position Summary:

This role is to verify a patient's insurance benefits and obtain pre-authorization for medical services or procedures, ensuring coverage before the service is rendered. Key duties include verifying eligibility, gathering necessary information from physicians, communicating with insurance companies, documenting all details, and informing patients about their coverage. This role requires strong communication, attention to detail, and knowledge of medical terminology and insurance policies.

Essential Functions and Responsibilities:

• Verify insurance and benefits: Confirm patient eligibility and benefits for scheduled procedures with various insurance carriers (e.g., Medicare, Medicaid, commercial).
• Obtain pre-authorization: Secure the required prior approval from insurance companies for medical services, prescriptions, or treatments.
• Gather information: Collect necessary medical documentation from referring physicians and clinical staff to support the authorization request.
• Communicate with stakeholders: Act as a liaison between patients, physicians, insurance representatives, and facility staff.
• Document and manage records: Accurately enter all information into the practice management system and maintain records of authorizations, denials, and appeals.
• Address issues: Follow up on pending authorizations, resolve problems, and handle any issues that arise during the process.
• Inform patients: Explain insurance coverage, authorization status, and any financial responsibilities to the patient.

Qualifications:

• High school diploma or equivalent is typically required, with an associate degree being a plus.
• Prior experience in medical billing, insurance authorization, or a similar role is strongly preferred.
• Strong communication and customer service skills are essential.
• Detail-oriented with basic computer skills, including experience with electronic medical records software and electronic health records (EHR).
• Knowledge of medical terminology is beneficial.
• Must be able to manage a high volume of work and meet deadlines.

Education and Certifications:

• High school diploma or equivalent (required); associate degree or higher a plus.

Benefits:

• 401(k) company contribution of 7.5% annual salary (whether you contribute or not)
• Dental insurance
• Health insurance
• Vision
• Company Paid Life insurance 20k
• Company Paid AD&D 20K
• Company Paid Long-Term Disability 60%
• 6 Days of Sick Time
• 8 Paid Holidays
• 10 Days of Vacation Time
• Milestone Checks
• Cabin/Condo for vacations

EEOC Statement:

First Urology provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. May be required to undergo background check and/or drug screen.