Pre-Certification Specialist

The Cardiac & Vascular Institute • Gainesville, FL

8h

About The Position

JOB TITLE: Pre-Certification Specialist Hour of Work: Monday – Friday Shift : Day Employment Type : Non-Exempt Direct Report: Hospital Scheduling Manager Director : Director of Clinical Support Key Responsibilities - Pre-certify insurance and obtain authorizations for all office appointments (Office Visits, Testing, Nuclear, and PET) - Submit denied authorization requests for Clinical Review, Peer-to-Peer Review, or file appeals with the insurance company. - Verify patient insurance information prior to appointment date. - Scan all documentation regarding cardiac procedures, testing, and referrals. - All other duties as assigned. - The job holder must demonstrate current competencies applicable to the job position. Qualifications/Requirements - High School graduate or GED - Minimum 1 year insurance experience in a health care organization or specialty practice, preferably Cardiology-based. - Proficiency in standard EHR and Practice Management software is required. - Proficiency in medical terminology with emphasis on Cardiology. - Working knowledge of insurance guidelines and terminology as well as CPT and ICD-10 coding. - Basic knowledge of electronic medical records retrieval system, computers, and the Internet. - Perform multiple tasks and meet deadlines. - Communicate effectively, efficiently, and professionally. - Knowledge of Intergy and Medical Manager systems highly preferred.

Requirements

• High School graduate or GED
• Minimum 1 year insurance experience in a health care organization or specialty practice, preferably Cardiology-based.
• Proficiency in standard EHR and Practice Management software is required.
• Proficiency in medical terminology with emphasis on Cardiology.
• Working knowledge of insurance guidelines and terminology as well as CPT and ICD-10 coding.
• Basic knowledge of electronic medical records retrieval system, computers, and the Internet.
• Perform multiple tasks and meet deadlines.
• Communicate effectively, efficiently, and professionally.

Nice To Haves

• Knowledge of Intergy and Medical Manager systems highly preferred.

Responsibilities

• Pre-certify insurance and obtain authorizations for all office appointments (Office Visits, Testing, Nuclear, and PET)
• Submit denied authorization requests for Clinical Review, Peer-to-Peer Review, or file appeals with the insurance company.
• Verify patient insurance information prior to appointment date.
• Scan all documentation regarding cardiac procedures, testing, and referrals.
• All other duties as assigned.
• The job holder must demonstrate current competencies applicable to the job position.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED