Precertification Specialist

Responsibilities/Requirements:

• Pre-certify all patients for office visits, consultations, testing, and procedures as required by each patient’s insurance company by monitoring patient schedules in the billing system for each department
• Follow insurance company pre-certification requirements for approval, such as calling, faxing, emailing, logging into their system online, etc.
• Assist accounts receivable, coding, registration, and insurance follow up staff on an as-needed basis
• Answer requests from various departments regarding pre-cert requirements for various insurance companies
• Reviews pre-cert requirements for insurance companies in a timely manner to maintain up-to-date knowledge of requirements
• Notifies appropriate staff on status of approval/denials.
• Forwards denials to manager and appropriate staff for further review and decision making
• Maintains strict confidentiality
• Performs related work as required

Must also possess:

• HS/GED required
• Ability to communicate effectively with patients, DOC physicians and staff
• Ability to work under pressure and deadlines
• Outstanding organizational, verbal and writing skills
• Independent, highly motivated
• Exhibit initiative and self-discipline
• Proven positive, “teamwork” attitude and work history
• Previous insurance precert experience preferred
• Previous surgery or procedure scheduling preferred

Physical Demands:

• Must be able to use arms, hands, and fingers skillfully
• Constant sitting for long periods of time
• Must be agile and able to work efficiently in space limited areas
• Consistently work at a productive pace