Pre-Certification Specialist (32056

Position: Pre-Certification Specialist (32056)
Position purpose

Responsible for the communicating with insurance companies to ensure proper certification/authorization is obtained prior to patient's appointment and all scheduled tests and procedures.

Responsibilities/Duties/Functions/Tasks:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

* Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.

* Contact insurance companies as needed to obtain precertification and record on form data entry.

* Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.

* Documents, within the practice management system, all required information to include financial responsibility.

* Verify waivers have been signed as needed for tests and procedures prior to date of service.

* Communicate with staff on any adjustments on precertification.

* Light data entry and other related office duties.

* Other duties as assigned.

Qualifications

Education:

High School diploma or GED.

Experience:

Minimum of two (2) years of pre-certification experience required.

Requirements for Level I Status:

* Entry level (1-4 years' experience) and/or meet the basic requirements of the job with the need for additional supervision.

* Excess of 4 years' experience if meeting only the basic requirements of the job with need for additional supervision.

Additional Qualifications:

Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.

Performance Requirements:

* Excellent communication skills, both written and verbal.

* Proficient technical (computer) skills.

* Ability to multi-task and prioritize.

* Self-motivated with initiative.

* Strong sense of ethics.