Pre-Certification Representative

This is a fully remote position, open to applicants in Washington.

📋 Description

• Acquire and supply precise and comprehensive data input for precertification/preauthorization from insurance providers.

• Collaborate with insurance companies to secure pre-certification for services rendered.

• Contact health plans to obtain precertification prior to patient appointments.

• Analyze documented clinical information and convey relevant medical/clinical data to insurance providers.

• Send pre-certification request forms via fax to insurance companies.

• Uphold confidential files and scan/input data utilizing the host system.

• Confirm medical insurance details and documentation in scheduling/registration modules.

• Examine claim denials and rejections.

• Input and update patient and other relevant data in the computer system.

• Conduct patient intake, insurance verification, copay/patient liability notifications, and demographic confirmations.

• Utilize MPower, client host systems, and additional tools to collect payments and resolve accounts.

• Liaise with physician offices and patients.

• Make outbound calls to patients regarding precertification notifications.

• Operate autonomously from assigned work queues.

• Maintain confidentiality and adhere to HIPAA and information security policies.

• Achieve departmental productivity and quality benchmarks.

• Execute other responsibilities as assigned by management.

⛳️ Requirements

• High School diploma or equivalent is mandatory.

• Knowledge of medical terminology is essential.

• A minimum of 2-3 years of experience in healthcare or physician’s office related to obtaining and managing pre-authorizations is required.

• Extensive familiarity with individual payor websites, including eviCore, Navinet, and Novitasphere.

• Proficiency in Medical Terminology, CPT Codes, Modifiers, and Diagnosis Codes.

• Ability to thrive both independently and within a team setting.

• Strong organizational skills and ability to prioritize tasks effectively.

• Experience with GE Centricity or EPIC PB is preferred.

• Excellent oral and written communication skills.

• Proficiency in Microsoft Office Suite is required.

• Strong interpersonal skills with the ability to communicate effectively at all organizational levels.

• Exceptional problem-solving and creative skills, with the capacity to exercise sound judgment and make decisions based on accurate and timely analyses.

• High integrity and dependability, coupled with a strong sense of urgency and results-oriented approach.

• Outstanding written and verbal communication skills are essential.

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance plans.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and growth.

• Retirement savings plan with employer matching.

• Employee assistance programs and wellness initiatives.