Precertification Specialist

Precertification Specialist

We are hiring a Precertification Specialist for an exciting opportunity to join our growing team!

This will be a hybrid role after 2 to 4 weeks of training. Training is in our Regional Support office M-F from 8-5. After completing training you will work 4 days remote / 1 day at our Regional Support office in Alpharetta.

Hours: Monday-Friday, 8AM - 5PM, no nights or weekends

Duties may include but not limited to:

• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential issues.
• Utilize ICD-10 and CPT codes to ensure proper authorization for procedure and claims payment.
• Responsible for explaining benefits, the billing process and financial responsibilities to patients.
• Responsible for ensuring treatment is medically necessary, align with established standards, payer guidelines and are approved within the required timeframe.
• Maintain accurate documentation of authorization and other related information.
• Utilization of payer portals
• Record all communication with providers and personnel in standardized documentation and proper format
• Review denial reasons and follow the appeal process in a timely manner. Arrange peer to peer, if applicable.
• Provides detailed, accurate and current clinical information to insurance representatives complying with HIPAA regulations.

Requirements:

• Dependable team player is a must.
• Ability to work in a fast paced environment.
• Prior medical experience is required.

Heart and Vascular Care is a cardiology practice that places a priority on compassionate patient care and service. In our team-based and family-oriented setting, we strive to set a new bar for patient healthcare through a modern, friendly, and thoughtful approach.

Come be a part of our growing team. Apply and someone will be in touch!