Pre-Certification Representative

Job Description:

• Obtain and provide accurate and complete data input for precertification/preauthorization from insurance companies
• Work with insurance companies to obtain pre-certification for services
• Call health plans to obtain precertification before patient appointments
• Interpret documented clinical information and relay pertinent medical/clinical information to insurance companies
• Fax pre-certification request forms to insurance companies
• Maintain files and security of confidential information using host systems to scan and input data
• Verify medical insurance information and documents in scheduling/registration modules
• Review claim denials and rejections
• Enter and update patient and general data in computer systems
• Perform patient intake, insurance verification, copay/patient liability notification, and demographic confirmation
• Use MPower workflow, client host systems, and other tools to collect payments and resolve accounts
• Communicate with physician offices and patients
• Make outbound calls to patients regarding precertification notifications
• Work independently from assigned work queues
• Maintain confidentiality and comply with HIPAA and PHI requirements
• Meet daily productivity and quality standards
• Follow client/team policies and procedures
• Perform other duties assigned by management

Requirements:

• High School diploma or equivalent required
• Medical terminology knowledge required
• Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations required
• Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere required
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
• Ability to work well individually and in a team environment
• Strong organizational and task prioritization skills
• Experience with GE Centricity or EPIC PB preferred
• Strong communication skills/oral and written
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills and ability to communicate well at all levels of the organization
• Strong problem-solving and creative skills, with the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability, with a strong sense of urgency and results orientation
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
• Ability to follow directions, collaborate with others, and handle stress
• Must be able to perform the listed physical demands, including sitting, manual tasks, operating office equipment, extending arms, kneeling, talking, and hearing
• Must understand and comply with Information Security and HIPAA policies and procedures

Benefits:

• Remote work
• Use of a smartphone or electronic device for multifactor authentication and security purposes