Pre-Certification Specialist (31030)

Position purpose

Responsible for the communicating with insurance companies to ensure proper certification/authorization is obtained prior to patient’s appointment and all scheduled tests and procedures.

Responsibilities/Duties/Functions/Tasks:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.
• Contact insurance companies as needed to obtain precertification and record on form data entry.
• Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.
• Documents, within the practice management system, all required information to include financial responsibility.
• Verify waivers have been signed as needed for tests and procedures prior to date of service.
• Communicate with staff on any adjustments on precertification.
• Light data entry and other related office duties.
• Other duties as assigned.

Qualifications

Education: High School diploma or GED.

Experience: Minimum of two (2) years of pre-certification experience required.

Requirements for Level I Status:

 

• Entry level (1-4 years’ experience) and/or meet the basic requirements of the job with the need for additional supervision.
• Excess of 4 years’ experience if meeting only the basic requirements of the job with need for additional supervision.

Additional Qualifications:  Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.

Performance Requirements:

• Excellent communication skills, both written and verbal.
• Proficient technical (computer) skills.
• Ability to multi-task and prioritize.
• Self-motivated with initiative.
• Strong sense of ethics.