Title: Operations Specialist 1
Duration: 6 months 
Location:Houston, TX (Hybrid - 3 days/week onsite)

Contract-to-hire

Description:

• Accurately complete all fields in the patient demographic and insurance screens within the computer system.
• Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.
• Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
• Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test.
• Assist patients with scheduling new patient office visits with CVCP provider offices.
• Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.
• Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline.
• Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing.
• Correct any account in which errors have occurred per the assigned deadline.
• Maintain constant communication among the physician, insurance company, and CVCP regarding authorization and the CVCP authorization status on patients.
• Maintain a minimum average of 30 CVCP authorizations per day with proven accuracy after 3 months.

Required Experience / Qualifications

• Minimum 2 years of experience in working in precertification
• Working knowledge of managed care in all areas, most notably: referrals, insurance verification, and precertification.
• Knowledge of medical terminology
• Familiarity with ICD-9 and ICD-10
• Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bill
• Detail-oriented and strong critical thinking skills for solving problems on your own
• Ability to perform multiple tasks simultaneously and problem solve efficiently
• Excellent organizational and interpersonal skills
• Strong desire to learn and utilize technology effectively
• Some experience with Microsoft Office including Teams
• Quickly able to enter data accurately and understand the information entered
• Flexibility to work overtime occasionally, typically when onboarding new clients

  
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 24.00/hr.