Pre-Certification Representative

Med Metrix•Aberdeen, WA

About The Position

The Pre-Certification Representative obtains and provides accurate, complete data for precertification and preauthorization requests to insurance companies. The role involves coordinating with health plans, physician offices, and patients; interpreting documented clinical information; verifying insurance and patient information; processing and updating records; and supporting account resolution and payment collection using available workflow and host systems. The representative works independently from assigned work queues while meeting departmental productivity and quality standards. The position requires maintaining confidentiality and handling protected health information in accordance with HIPAA and information security policies. The employee must also follow client and team procedures and maintain a professional, customer-service-oriented approach.

Requirements

High school diploma or equivalent.
Knowledge of medical terminology.
At least 2–3 years of healthcare or physician’s office-related experience obtaining and handling pre-authorizations.
Extensive knowledge of individual payor websites, including eviCore, Navinet, and Novitasphere.
Knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes.
Ability to work effectively both individually and in a team environment.
Strong organizational and task-prioritization skills.
Strong oral and written communication skills and the ability to communicate at all levels of the organization.
Proficiency in Microsoft Office Suite.
Strong interpersonal, problem-solving, and creative skills, with sound judgment and the ability to make decisions based on accurate and timely analyses.
High integrity and dependability, with a strong sense of urgency and results orientation.
A gracious and welcoming personality for customer service interactions.
Ability to follow directions, collaborate with others, and handle stress.
Possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

Nice To Haves

Experience with GE Centricity or EPIC PB.

Responsibilities

Work with insurance companies and health plans to obtain precertification for services before patient appointments.
Call health plans to obtain required precertification and relay pertinent medical or clinical information based on documented information.
Fax precertification request forms to insurance companies.
Maintain files and protect confidential information; scan and enter data into the host system according to established procedures.
Verify medical insurance information and document it in scheduling and registration modules.
Review claim denials and rejections.
Accurately enter and update patient and other data in the computer system.
Perform patient intake, insurance verification, notification of copays or patient liability, and confirmation of demographics.
Meet and maintain daily productivity and quality standards established by departmental policies.
Use the MPower workflow system, client host system, and other available tools to collect payments and resolve accounts.
Communicate effectively with physician offices and patients, including making outbound calls to notify patients about precertification.
Work independently from assigned work queues and adhere to client and team policies and procedures.
Maintain confidentiality and use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
Comply with information security and HIPAA policies and procedures, limiting access to PHI to the minimum necessary to perform assigned duties.
Maintain a professional attitude and perform other duties as assigned by the management team.