Pre-Certification Representative

Med-Metrix•Aberdeen, WA

10d

About The Position

The Pre-Certification Representative obtains and provides accurate, complete information for precertification and preauthorization requests to insurance companies. The role works with health plans, physician offices, and patients to secure authorizations before appointments, communicate relevant clinical information, verify insurance, and maintain accurate patient and account records. The representative uses workflow and client systems to manage assigned work, resolve accounts, and meet departmental productivity and quality standards. The role also involves handling confidential patient information in accordance with HIPAA and information security policies. The employee must be able to work independently and collaboratively, communicate professionally, follow directions, and handle stress. The work environment is usually quiet, and the position requires use of a smartphone or other electronic device capable of downloading applications for multifactor authentication and security.

Requirements

High school diploma or equivalent.
Medical terminology knowledge.
At least 2–3 years of healthcare or physician’s office 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 independently and in a team environment.
Strong organizational and task-prioritization skills.
Strong oral and written communication skills, including the ability to communicate at all levels of the organization.
Proficiency in Microsoft Office Suite.
Strong interpersonal skills.
Strong problem-solving and creative skills, sound judgment, and ability to make decisions based on accurate and timely analyses.
High integrity and dependability, with a strong sense of urgency and a results-oriented approach.
Excellent written and verbal communication skills.
Gracious and welcoming personality for customer service interactions.
Ability to follow directions, collaborate with others, and handle stress.
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.
Interpret documented clinical information and relay relevant medical or clinical details to insurance companies.
Fax precertification request forms to insurance companies.
Maintain files and protect confidential information; scan and input data using the host system according to established procedures.
Verify medical insurance information and documents in scheduling and registration modules.
Review claim denials and rejections.
Accurately enter and update patient and other general data in the computer system.
Perform patient intake, including insurance verification, communicating copays and patient liability, and confirming 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.
Follow policies and procedures established for the client and team.
Communicate effectively with physician offices and patients.
Make outbound calls to patients to provide precertification notifications.
Work independently from assigned work queues.
Maintain confidentiality and a professional attitude.
Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
Comply with information security and HIPAA policies and procedures, and limit viewing of PHI to the minimum necessary to perform assigned duties.
Perform other duties as assigned by the management team.