Hospital Pre-Certifications

Description

Georgia Urology is looking to hire a full-time, Precertification Specialist. The chosen candidate will take a hands‑on approach to understand insurance rules and requirements daily. The Precertification Specialist will be responsible for getting authorizations for hospital procedures via portal or calling the payor. The candidate will be organized, dependable, and have exceptional communication skills. This position will require communication with various other departments, patients, and insurance companies.

• Responsible for obtaining pre-certifications as needed per insurance companies’ guidelines.
• Stay up to date on insurance rules, criteria, and other appropriate changes.
• Obtain authorizations in a timely manner with a high degree of accuracy.
• Review clinical data matching it against specified medical terms and follow established criteria by insurance companies.
• Communicate with the appropriate clinical staff regarding insurance approvals/denials.
• Appeal any denials that relate to authorization issues.
• Document authorization information in EHR and enter information for claim attachment.
• Self‑motivated, positive, and enthusiastic while maintaining a high degree of professionalism.
• Very strong written and verbal communication skills.
• Ability to work independently while demonstrating excellent organization and collaboration lafiya skills.
• Demonstrates flexible and efficient time management and the ability to prioritize workload.
• Learns quickly and uses strong critical thinking and problem‑solving skills.
• The ability to grow and learn new skills.
• Maintains confidentiality and adheres to all HIPAA guidelines and regulations.

Requirements

• High School Diploma or GED.
• One‑year experience with medical pre‑certification.

• Knowledge of medical billing and collection practices.
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Skilled in Microsoft Office.
• Adaptable, flexible and a fast learner.
• Ability to multitask, to manage time and meet time-sensitive deadlines.
• Must be well organized and detail oriented.
• Must have a strong customer service focus.