Pre-Certification Specialist (32283)

Qualifications

• High School Diploma or Equivalent.
• Certified as a CMA, MOA, or Billing and Coding is preferred.
• A minimum of two (2) years’ experience in the medical field or physician office practice is preferred.
• Must pass a basic background check for criminal history, drug screening, and OIG exclusions.

Responsibilities

• Obtain and maintain prior authorizations from insurance companies regarding procedures both in-office and outlying facilities, as well as medications or testing ordered by the providers.
• Collaborate with providers, clinical staff, and others to timely resolve any authorization gaps identified.
• Ensure clinical information submitted for peer review and entered into the patient’s electronic record is the most accurate and up to date.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
• Handle VA authorization numbers and follow-ups.
• Check the patient's insurance benefits and determine the amount owed prior to the procedure.
• Ensure appropriate notification of patients regarding their financial responsibility, benefit coverage, and payor authorization for services to be provided as needed.
• Perform any other duties deemed necessary by the Clinical Director.

Skills

• Solid working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits, in addition to medical terminology.
• Ability to communicate and interact effectively and professionally with patients, coworkers, and other practice customers.
• Ability to work autonomously with minimal supervision on assigned tasks as well as accept direction and real-time coaching on given tasks.
• Ability to prioritize in a fast-paced environment.
• Maintain the medical record, ensuring confidentiality and accuracy in accordance with organization standards and HIPAA laws.