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SalaryPre-Certification Specialist - Full Time (Remote)
Days: Monday-Friday
Hours: 8:30a-5p
Job Summary:
The Pre-Certification Specialist, under the direction of the Pre-Certification Manager, is responsible for getting authorizations for inpatient and outpatient surgery, diagnostic tests, injections and medications. Regular attendance is an essential part of this job. Candidate must be available to come on-site for 6 month training period. Candidate must live within a 30 mile radius of Evansville, IN to attend in-person training and company meetings as necessary..
Essential Functions:
Responsible for obtaining pre-certifications as needed per insurance companies requirements.
Stay up to date on insurance rules, criteria’s and other pertinent changes.
Obtain authorizations timely and with a high degree of accuracy. Department goal is to verify scheduled procedures at least 4 weeks prior to the date of service.
Give priority to add-ons and make every effort to complete prior to service
Review clinical data matching it against specified medical terms and follow established criteria by insurance companies
Communicate with the appropriate clinical staff regarding insurance approvals/denials
Provide status updates to nurse, physician and patient as needed
Appeal any denials that relate to authorization issues
Document authorization information in EMR and enter information for claim attachment
Review all incoming pre-certification mail
Verify with facilities that they participate in a patient’s insurance plan
Provide authorization information to facility where patient is scheduled
Answer phone calls associated with pre-certifications
Fax records to insurance companies, doctors’ offices, surgery centers, hospitals, etc.
Verbally provide clinical information over the phone to insurance companies.
Additional Responsibilities:
Cover for associates when on vacation, leave, etc.
Check benefits upon patient or nurse request
Job Qualifications:
Insurance background with prior authorization experience preferred.
Ability to maintain good working relationships with co-workers, management, and other staff.
Ability to multitask
Must possess excellent time management skills
Must have excellent communication and organizational skills
Provide excellent customer service by appropriately responding to inquiries from clinical staff, physician and/or patients.
Days: Monday-Friday
Hours: 8:30a-5p
Job Summary:
The Pre-Certification Specialist, under the direction of the Pre-Certification Manager, is responsible for getting authorizations for inpatient and outpatient surgery, diagnostic tests, injections and medications. Regular attendance is an essential part of this job. Candidate must be available to come on-site for 6 month training period. Candidate must live within a 30 mile radius of Evansville, IN to attend in-person training and company meetings as necessary..
Essential Functions:
Responsible for obtaining pre-certifications as needed per insurance companies requirements.
Stay up to date on insurance rules, criteria’s and other pertinent changes.
Obtain authorizations timely and with a high degree of accuracy. Department goal is to verify scheduled procedures at least 4 weeks prior to the date of service.
Give priority to add-ons and make every effort to complete prior to service
Review clinical data matching it against specified medical terms and follow established criteria by insurance companies
Communicate with the appropriate clinical staff regarding insurance approvals/denials
Provide status updates to nurse, physician and patient as needed
Appeal any denials that relate to authorization issues
Document authorization information in EMR and enter information for claim attachment
Review all incoming pre-certification mail
Verify with facilities that they participate in a patient’s insurance plan
Provide authorization information to facility where patient is scheduled
Answer phone calls associated with pre-certifications
Fax records to insurance companies, doctors’ offices, surgery centers, hospitals, etc.
Verbally provide clinical information over the phone to insurance companies.
Additional Responsibilities:
Cover for associates when on vacation, leave, etc.
Check benefits upon patient or nurse request
- The preceding examples are representative of the assignments performed by this position and are not intended to be all-inclusive.
Job Qualifications:
Insurance background with prior authorization experience preferred.
Ability to maintain good working relationships with co-workers, management, and other staff.
Ability to multitask
Must possess excellent time management skills
Must have excellent communication and organizational skills
Provide excellent customer service by appropriately responding to inquiries from clinical staff, physician and/or patients.
