Summary: The Precert Specialist verifies insurance coverage and benefits for a wide range of testing, procedures, evaluations, treatments, etc. ordered for the patient.

 

General Summary of Duties: (Other duties may be assigned.)

• Contact insurance company to verify patient coverage and obtain information concerning extent of benefits
• Completes forms as required by insurance to permit treatment by provider
• Review chart documentation to ensure patient meets medical policy guidelines
• Prioritize incoming authorization requests according to urgency
• Obtain authorization via payer website or by phone and follow up regularly on pending cases
• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
• Initiate appeals for denied authorizations
• Respond to clinic questions regarding payer medical policy guidelines
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
• Properly utilize EMR system and remain up to date on required training and procedures related to EMR system
• Secure patient information and maintain patient confidentiality
• Assist in coverage of other staff when necessary; Participate in orientation of employees when needed    
• Communicate efficiently with other departments to ensure best care for patient

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required

Education and Training:

• High School diploma or equivalent required at minimum
• Experience working in related position preferred

Physical Demands and Working Conditions/Requirements:

• Requires prolonged periods of sitting at desk, working at computer, and being on the phone
• Must have good computer and telephone communication skills and able to operate misc. office equipment
• Hearing and vision abilities within normal range, or corrected, to observe and communicate with patients and staff
• Ability to work in fast-paced environment in a professional medical office setting
• Reasonable accommodations may be made to enable individuals with disabilities to perform the necessary functions

Position Type and Expected Hours of Work:

Full time: 40 hours minimum per week; available for overtime as needed; varied day shift hours on week days

Travel Requirements:

No travel anticipated

Full-time Benefits

• Health, Dental, and Vision Insurance
• 401k Plan, 3% Safe Harbor Non-Elective Employer Contribution
• Employer-provided $25,000 Group Life Insurance
• Voluntary Life Insurance
• Short-Term and Long-Term Disability
• Accident, Hospital, Critical Illness/Cancer Benefits
• Mileage Reimbursement for travel between office locations
• Certificate and Continuing Education Reimbursement
• Accrual Paid Time Off (up to 19 days off within 1st year) 
• 6 Paid Holidays Per Year
• Closed on Major Holidays