Job Description

Precertification Specialist Position Overview:

The pre-certification specialist is responsible for pre-certification of patient appointments and procedures according to DME and diagnostic protocols.

Precertification Specialist Essential Functions/Responsibilities (other duties may be assigned):

Pre-certify evaluation and treatment as required by insurance provider and documents appropriately for DME and diagnostic testing. Verify insurance eligibility and benefits online or by phone. Updates insurance policy information in EMR as required, such as completion of Notification of Benefits form. Verify receipt of all necessary pre-authorization documents prior to treatment. Communication: Effectively correspond with the team through the EMR system, email and or phone calls. Provide patients with estimated written documentation of covered therapy benefits per the patient's insurance coverage Scheduling and Registration: Collects co-payments according to insurance plan information appointment type and documents if needed on co-pay record Answers patient questions and responds professionally to patient concerns, i.e., pleasant tone of voice, smile, use courteous language, etc. Ensures that related follow-up work is completed in a timely manner (same day or by next day), including relaying message to clinicians to return calls Uses Precertification protocols including insurance coverage to determine the most appropriate approach to scheduling patients Makes outgoing calls to reschedule appointments as needed or to provide patient reminders of appointment times and information needed for appointments, insurance cards, etc. Various clerical duties including copying, faxing, scanning, and filing

Precertification Specialist Required Education,

Skills

and Experience:

High School Diploma/ GED equivalent Ability to establish and maintain effective working relationships with patients, other employees, and the public 2 + years' admin support in a medical environment preferred Knowledge about health insurance, pre-authorization, insurance verification, medical terminology, CPT codes and ICD-10 codes preferred Must have excellent customer service skills Able to work in a fast-paced and demanding work environment Must demonstrate a strong work ethic and maintain professionalism at all times Must have a team mentality, flexibility and willingness to learn The ability to communicate effectively, multi-task and work under pressure is the key to success in this position, which also requires attention to detail and a commitment to achieving consistent customer satisfaction. The ability to uphold HIPAA compliance is mandatory. Must exercise good judgment and discretion Technologically savvy; proficient in Microsoft 365 products, including Word, Excel, Outlook, and Teams

Precertification Specialist Physical Requirements:

The physical demands described here represent those required to perform essential job functions. Reasonable accommodation may be made for individuals with disabilities. While performing this role, the employee must regularly:


Sit, talk, hear, and use hands to write, type, or operate office equipment Occasionally reach with hands and arms; climb, balance, stoop, kneel, crouch, crawl, and smell Perform repetitive motions, including reaching overhead and typing Lift up to 50 pounds occasionally and carry objects weighing up to 25 pounds Maintain peripheral vision, depth perception, and focus adjustments

Precertification Specialist Benefits Offered:

Health Insurance (Single & Family plans available) Life Insurance Disability Insurance 401(k) plan with Company Match Employee Discount Program Paid Time Off Paid Holidays





Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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