Precertification Specialist

Heart and Vascular Care Inc•Alpharetta, GA

6d•Hybrid

About The Position

We are hiring a Precertification Specialist for an exciting opportunity to join our growing team! This is a HYBRID REMOTE Position - work schedule (4 days remote / 1 day in office in Alpharetta) - after training. Training is 2 - 4 weeks M-F (8a - 5p) in our Regional Support Office in Alpharetta. Heart and Vascular Care is a cardiology practice that places a priority on compassionate patient care and service. In our team-based and family-oriented setting, we strive to set a new bar for patient healthcare through a modern, friendly, and thoughtful approach. Come be a part of our growing team. Apply and someone will be in touch!

Requirements

Medical insurance precertification experience.
Basic medical precertification skills.
Dependable team player is a must.
Ability to work in a fast paced environment.
Prior medical experience is required.

Responsibilities

Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential issues.
Utilize ICD-10 and CPT codes to ensure proper authorization for procedure and claims payment.
Responsible for explaining benefits, the billing process and financial responsibilities to patients.
Responsible for ensuring treatment is medically necessary, align with established standards, payer guidelines and are approved within the required timeframe.
Maintain accurate documentation of authorization and other related information.
Utilization of payer portals
Record all communication with providers and personnel in standardized documentation and proper format
Review denial reasons and follow the appeal process in a timely manner. Arrange peer to peer, if applicable.
Provides detailed, accurate and current clinical information to insurance representatives complying with HIPAA regulations.