Precertification Specialist

Job Summary
We are seeking a detail-oriented and knowledgeable Precertification Specialist to join our team. The Pre-Certification Specialist, under the supervision of the Practice Support 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.

Duties

• Responsible for obtaining in and out of network authorizations for both Physical and Occupational Therapy.
• 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.

Experience

• Previous experience in a medical or dental office setting is preferred.
• Familiarity with insurance verification processes is highly desirable.

Qualifications

• Previous pre-certification/ referral experience preferred.
• Excellent verbal and written skills.
• Strong organizational skills.
• Ability to Multi-task.
• 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.

Pay: $16.00 - $19.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• Precertification: 2 years (Required)

Work Location: In person