Precertification Specialist

Job Details

Level

Experienced

Job Location

MCKINNEY, TX

Remote Type

Fully Remote

Position Type

Full Time

Education Level

High School

Job Category

Billing

Description

Position Title: Precertification Specialist

Department: Precertification

Reports To: Precertification Manager

FLSA: Non-Exempt

Position Summary:

As a Precertification Specialist you will play a crucial role in ensuring the accurate and timely precertification of medical procedures and services. This position is pivotal in maintaining seamless patient care and operational efficiency. You will utilize your attention to detail, strong communication skills, and ability to navigate payer requirements to contribute to our commitment to delivering exceptional healthcare services.

Essential Duties & Responsibilities:

Accurately enter payer information into multiple databases and follow established procedures for distributing information for further review.
Follow up with carriers to obtain precertification numbers and file completed requests according to established procedures.
Continuously monitor schedules to ensure the most current data is maintained.
Verify benefits for each case and document accounts appropriately, especially for workers' compensation and motor vehicle accident cases.
Obtain precertification for each case and ensure that all necessary documentation is promptly uploaded to patient files.
Document all pertinent information and communications in the designated database system.

Qualifications

Qualifications & Requirements:

Education Licenses/Certifications:

High School Diploma or equivalent. Bachelor’s degree preferred

Experience:

2 years’ Insurance Verification experience required.
Out of Network experience preferred.

Skills & Competencies:

Strong organizational skills with the ability to prioritize tasks effectively in a fast-paced environment.
Excellent written and verbal communication skills.
Ability to work independently and as part of a team.
Ability to interpret an Explanation of Benefits and take additional necessary steps toward payment.
Familiarity with Microsoft applications and database software.
Attention to detail and accuracy in data entry and documentation.
Proficient in utilizing available tools and equipment to complete tasks efficiently.
Capable of working independently with minimal supervision.

Working Conditions:

Generally, work in an office environment.
Frequent and prolonged periods of computer and office equipment usage.
Standard business hours with occasional overtime to meet project deadlines.
Ability to manage stress and maintain productivity under tight deadlines and changing priorities.
Regular interaction with team members, clients, and other stakeholders through various communication channels.

Physical Demands:

Ability to maintain a stationary position for extended periods.
Occasionally required to move short to moderate distances.
Must be able to lift and/or move up to 50 pounds occasionally.

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Employees must be able to perform the essential functions of the position satisfactorily. Furthermore, the statements do not establish a contract for employment and are subject to change at the discretion of the Company with or without advance notice.

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Precertification Specialist

Job Details

Description

Qualifications

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