Surgery Precertification Specialist – WHEATON EYE CLINIC – Wheaton, IL

Founded 80 years ago, the Wheaton Eye Clinic is a nationally recognized multi-subspecialty ophthalmology practice that spans the western suburbs of Chicago with offices in Wheaton, Naperville, Hinsdale, Saint Charles, Bartlett, and Plainfield and an ophthalmology-specific ambulatory surgery center at the main office in Wheaton. Dedicated to our mission of providing exceptional eye care, our 32 ophthalmologists and 7 optometrists in every ophthalmic subspecialty are highly respected in the region and have superb relationships with referring colleagues and health systems. We are currently looking to add to our Surgery Scheduling staff.

Under supervision of the Physician Support Manager, the Surgical Precertification Coordinator is responsible for obtaining preauthorization/precertification of all outpatient surgeries. The Surgical Precertification Coordinator will possess outstanding communication and customer service skills and the ability to handle multiple tasks within a designated time frame. The Coordinator will act as a liaison between our organization and insurance companies to promote the Wheaton Eye Clinic’s commitment to exceptional patient care.

• Contact insurance companies, HMO providers and/or local unions to initiate preauthorization for all outpatient surgeries. Provide clinical information and documentation by phone, online portal or fax.
• Communicate with primary care physicians and utilization management organizations to obtain surgery authorizations for HMO patients; submit clinical information and documentation by phone, online portal or fax.
• Follow up with requests in a timely manner to ensure a response is received with enough notice prior to surgery to prevent last-minute cancellations.
• In the event of a denial, the Coordinator will communicate the insurance’s decision with the surgeon, patient, facility and Surgery Scheduling staff accordingly.
• Work with the Insurance Department staff to investigate all denials, and with assistance from providers, submit appeals as necessary.
• Obtain authorizations for urgent add-on surgeries in a timely manner.
• Respond to inquiries by telephone and / or written correspondence using quality customer service.
• Respond to insurance companies’ or case managers’ requests for additional information.
• Respond to requests from primary care physician’s offices for additional information.
• Communicate with surgical facilities regarding preauthorization status.
• Respond to calls from patients requesting preauthorization information.
• Provide accurate, thorough and timely documentation of all information pertinent to patient treatment.
• Coordinate oculoplastic surgeries performed in a hospital / outpatient surgery center setting as well as in-office procedures. Ensure pre-payment for all cosmetic procedures.
• Assist with scheduling surgery.
• May be required to travel to any Wheaton Eye Clinic location.

Education: High school graduate or equivalent

• Ability to read, write and speak in a clear and professional manner required
• Knowledge of ICD-9/10 required
• 1 – 2 years insurance experience with knowledge of insurance coverage and claims processes preferred
• General knowledge regarding medical terminology preferred

Competitive wage and benefit package available including a generous 401(k) program

EOE