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Pre-Cert Specialist


Pre-Cert Specialist - REPORTS TO: Billing Supervisor, Practice Manager and Physicians.

DEFINITION OF POSITION: Responsible for obtaining pre-certifications from various insurance companies for test, procedures and surgeries.

Qualification:

  1. High school graduate.
  2. Able to read, write, and communicate.
  3. Displays a primary interest in giving good patient care and maintaining standards of courtesy and friendliness to co-workers.
  4. Maintain BLS certification.
  5. Able to comply with patient confidentiality and integrity policy on all matters.
  6. Certification encouraged.
  7. Knowledge of medical terminology

Responsibilities:

  1. Monitor scheduled procedures and maintain organized list with status of pre-certifications
  2. Verify insurance eligibility benefits via phone and/or internet access.
  3. Update insurance policy information in EMR
  4. Check insurance payment policy for scheduled procedures and obtain prior authorization.