Job description

Job Title: Pre-Certification Specialist

Job Type: Monday- Friday 8:00am- 5:00pm

Job Location: Johnson City, TN (Opportunity to work REMOTE)

Date Posted: 07/29/2022

Job Summary

The Pre-Certification Specialist, under the supervision of the Billing Manager is responsible for obtaining authorizations to ensure appropriate reimbursement for services rendered is obtained. The Pre-Certification Specialist works directly with patients, referring physician offices and payers to ensure payer guidelines are met prior to receiving care.

Responsibilities and Duties

• Responsibility for all authorizations which would include, but not limited to: Visco, Therapy, out of network authorizations, surgeries and MRI’s.
• Validates patient demographic data, identifies and verifies medical benefits and authorization requirements.
• Verifies insurance information through payer contacts, online resources or electronic verification systems and identifies payer authorization/ referral requirements.
• Provides appropriate documentation and follow up to patients and other departments regarding authorization/ referral requirements.
• Records detailed information related to authorizations/ referrals appropriately.
• Work collaboratively with insurance carriers to confirm/ verify eligibility and determine out of pocket costs as needed.
• Research and resolve with insurance payers any issues regarding pre-certifications.
• Answer calls/ questions regarding pre-cert issues.
• Additional duties as assigned.

Qualifications

• Knowledge of diagnosis codes and medical terminology.
• Previous pre-certification/ referral experience preferred.
• Excellent verbal and written skills.
• Strong organizational skills.
• Ability to Multitask.
• High level of comfort and ability to maneuver web base products.
• Excellent customer service and telephone etiquette.
• Understanding of insurance benefit requirements and out of pocket costs.
• Effective problem solving skills.
• Attention to detail.
• Good decision making.
• Computer proficiency with Windows, Outlook and Excel.
• Flexibility in cross training.
• Understands the importance of maintaining confidentiality per HIPAA guidelines.

Job Type: Full-time

Pay: $14.00 - $18.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: Hybrid remote in Johnson City, TN 37601

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