Precertification Specialist

:

Obtains pre-certification, prior approval or pre-determination authorization for scheduled tests and surgical procedures by contacting patient's insurance company for eligibility, pre-existing, or exclusions.

Responsibilities:

• Determines if testing or procedure is covered by patient's policy and whether prior authorization or a letter of pre-determination is required.
• Contacts insurance companies to provide patient medical history, current diagnosis and planned testing or surgical treatment.
• Interacts with assigned patient care teams to secure any additional documentation needed to obtain prior authorization.
• Continues to follow up with insurance companies to confirm status of requess, documenting approvals and/or denials in AllScripts and Experior.
• Partners with surgeon and patient care team to facilitate a peer-to-peer review or appeal if this is considered in the patient's best interest.
• Notifies billing manager and administration if there are any patterns that may require a change in documentation, work flows, etc.

Requirements:

• A High School Diploma is required.
• A minimum of 2-3 years experience in medical background required; at least 1 year of experience in pre-certification or insurance verification is preferred

Job Type: Full-time

Pay: From $17.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday
• No weekends

Experience:

• Surgical pre-certification: 2 years (Required)

Work Location: In person