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