Pre-Certification Specialist

Employment Type

Non-Exempt

Hospital Scheduling Manager

Director of Clinical Support

• Pre-certify insurance and obtain authorizations for all office appointments (Office Visits, Testing, Nuclear, and PET)
• Submit denied authorization requests for Clinical Review, Peer-to-Peer Review, or file appeals with the insurance company.
• Verify patient insurance information prior to appointment date.
• Scan all documentation regarding cardiac procedures, testing, and referrals.
• All other duties as assigned.
• The job holder must demonstrate current competencies applicable to the job position.

• High School graduate or GED
• Minimum 1 year insurance experience in a health care organization or specialty practice, preferably Cardiology-based.
• Proficiency in standard EHR and Practice Management software is required.
• Proficiency in medical terminology with emphasis on Cardiology.
• Working knowledge of insurance guidelines and terminology as well as CPT and ICD-10 coding.
• Basic knowledge of electronic medical records retrieval system, computers, and the Internet.
• Perform multiple tasks and meet deadlines.
• Communicate effectively, efficiently, and professionally.
• Knowledge of Intergy and Medical Manager systems highly preferred.