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UR Pre-Certification Specialist – Hospital Pickup and Denials
THS+UR Pre-Certification Specialist handling claim denials and pre-certification processes for OrthoCarolina Business Office in Charlotte. Requires knowledge of EMR and insurance verification processes.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical pre-certification processes, claims processing, and eligibility verification, while effectively liaising between departments to manage claim denials and appeals.
Highest-signal resume keywords
Medical Pre-CertificationClaims ProcessingEligibility VerificationDenials ManagementInterdepartmental Liaison
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingEligibility VerificationPre-CertificationDenials ManagementDocumentation Investigation
Soft Skills
CommunicationProblem-SolvingCollaboration
Tools & Technologies
EMR SystemsInsurance Websites
Industry Keywords
Authorization ProcessMedical CriteriaAppealsPayor LiaisonAR Department
About the role
Key responsibilities & impact- Receiving all OrthoCarolina claim denials for services not authorized for Surgery
- Familiarity with all areas of EMR (clinical, UR, transactions)
- Investigating documentation for all departments
- Understanding the authorization process, medical criteria, denials, and appeals
- Liaison between Payor, AR Department, Coding Department, and UR Department for all claim denials related to services not authorized
- Knowledge of claims processing, ability to verify eligibility and benefits.
Requirements
What you’ll need- Associate's degree preferred, but not required
- Two years of experience in medical pre-certification and pre-collection
- Experience in utilizing insurance website for verifying eligibility, benefits and obtaining pre-certification
Benefits
Comp & perks- Paid company holidays
- Wellness programs
- Tuition reimbursement