Cedar Gate Services

Precertification Specialist

Cedar Gate Services

Precertification Specialist

Cedar Gate Services Pvt. Ltd, Nepal, provides software research & development, data analytics, IT infrastructure management and various support services for Cedar Gate Technologies, USA. We employ 600+ professionals in our Sanepa office. For more information, visit company website at https://cedargate.com/ and follow our FB page at https://www.facebook.com/CGTNepal

Cedar Gate Services Pvt. Ltd, Nepal, provides software research & development, data analytics, IT infrastructure management and various support services for Cedar Gate Technologies, USA. We employ 600+ professionals in our Sanepa office. For more information, visit company website at https://cedargate.com/ and follow our FB page at https://www.facebook.com/CGTNepal

Precertification Specialist

Views: 5085 | This job is expired 1 week, 1 day ago

Basic Job Information

Job Category : IT & Telecommunication
Job Level : Entry Level
No. of Vacancy/s : [ 10 ]
Employment Type : Full Time
Job Location : Lalitpur, Nepal
Offered Salary : Negotiable
Apply Before(Deadline) : Feb. 22, 2024 23:55 (1 week, 1 day ago)

Job Specification

Education Level : Under Graduate (Bachelor)
Experience Required : Not Required

Job Description

The Precertification Specialist acts as a liaison between payers and healthcare providers, verifying patient insurance eligibility and benefits and obtaining precertification/pre-authorizations for all specified procedural orders.

Job Responsibilities

  • Call the patient’s insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions
  • Captures patient demographic, eligibility, and benefits information within applicable software systems
  • Obtain and document precertification/pre-authorization numbers from insurance companies prior to specified services per protocol
  • Complete all required steps necessary to process claims and re-route claims to the billing department per the assigned deadline
  • Correct any account in which errors have occurred per the assigned deadline
  • Obtain and document referral details and referral modifications for services and testing for patients with insurance plans requiring formal referral documentation
  • Maintain communication among healthcare providers, insurance companies, and offshore/onshore teams regarding the status of patient eligibility, benefits, patient authorization, and Client Auth status
  • Meet all department accuracy and productivity standards
  • Maintain appropriate records for area(s) of responsibility
  • Maintain confidentiality of all information in accordance with HIPAA
  • Maintain company confidentiality
  • Participate in continuing training to keep current on area of specialty
  • Complete additional duties and projects as assigned by management

Job Specification

  • Bachelor’s degree in any field
  • Computer experience including good working knowledge of the Microsoft Office Suite and internet
  • Strong English language written and verbal communication skills
  • Ability to work different shifts (Morning / Evening / Normal / Night)
  • Detail-oriented and strong critical thinking skills
  • Excellent organizational and interpersonal skills
  • Strong desire to learn and utilize technology effectively
  • Strong analytical and problem-solving skills
  • Excellent organizational and time management skills
  • Ability to perform assigned tasks independently
  • Ability to develop productive working relationships in a team environment
  • Knowledge of medical terminology will be an added advantage but not mandatory

Extensive training will be provided for this position, and candidates without prior experience are also encouraged to apply.


This job has expired.

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