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Thomas Eye Group · 1 day ago

PreCertification Financial Specialist

CBO - Atlanta, GA 30328

Full-time

Hybrid

Mid Level

Thomas Eye Group is seeking a PreCertification Financial Specialist to manage and monitor surgical cases and workflow tasks. The role involves ensuring timely completion of insurance verification, precertification, and authorization activities while serving as a liaison between providers and patients regarding financial processes.

Health Care

Responsibilities

Manage and monitor assigned surgical cases and workflow tasks, ensuring timely completion of insurance verification, precertification, and authorization activities

Verify insurance eligibility, benefits, and coverage limitations through payer portals and direct payer contact, and accurately document findings in ModMed

Review payer medical necessity guidelines and reimbursement policies to determine authorization and precertification requirements for scheduled procedures

Obtain and track prior authorizations and precertifications for surgical and clinical services to ensure compliance and prevent denials or cancellations

Accurately enter and maintain authorization numbers, approval dates, and supporting documentation in ModMed

Confirm receipt and completeness of all required clinical documentation and authorization approvals prior to scheduled procedures

Serve as a liaison between providers, surgery coordinators, ambulatory surgery centers (ASC), and external facilities regarding authorization and financial clearance

Prepare and communicate patient financial estimates, including procedure codes, anticipated charges, and out-of-pocket responsibility

Provide pre-operative financial counseling, educating patients on insurance benefits, deductibles, coinsurance, and payment expectations

Assist patients with financial assistance options, payment plans, or alternative funding resources when applicable

Collect required pre-payments for clinic and ASC services in accordance with organizational policies

Post, reconcile, and balance patient payments in ModMed; generate and review daily transaction reports for accuracy

Coordinate with Patient Accounts and Billing teams to resolve past-due balances prior to elective procedures

Notify patients of outstanding balances and pre-payment requirements related to elective surgical services

Process credit card and electronic check payments using approved payment platforms and procedures

Identify and resolve coding discrepancies to ensure accurate procedure documentation prior to authorization submission

Maintain consistent communication with Patient Access, scheduling, and clinical teams to support operational continuity

Provide cross-coverage and team support as needed to maintain department productivity

Perform additional duties as assigned to support Patient Access and revenue cycle operations

Qualification

Medical insurance pre-certificationCPT/ICD10 codingWeb based eligibility systemsWeb based benefit softwareMathematical abilityCustomer service skillsPhone skillsFollow up skills