Pre-Certification Specialist

CharterCARE Roger Williams Medical Center 7080-Cancer Center Providence , RI

Administrative support workers Full Time regular (64-80 hrs) , 1st Shift , 8:00 am - 4:30 pm

Summary:

Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals.

Education:

High School Graduate or GED required. Associate’s level degree preferred. Knowledge of CPT, ICD 10 coding and J Codes. Knowledge of insurance coverage’s and reimbursement practices.

Experience:

Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment.

• Strong verbal and written communication skills
• Ability to work both independently and as a member of a team
• Ability to remain organized and detail oriented while working at a fast past
• Ability to work independently as well as to function effectively and collaboratively in a team environment.
• Advanced organization skills and ability to handle multiple tasks.
• Proficient with computer applications, a thorough understanding of Microsoft Office suite, internet usage and the ability to learn and master other computer technology / software programs as needed.
• Excellent follow-through and persistence when communicating with patients and members of our community participating in our programs.