Cedar Gate Services

Software Companies

Precertification Specialist

Views: 5091|Published on: Apr 16, 2024

IT & Telecommunication

Entry Level

Full Time

Vacancy: 5

Lalitpur, Nepal|

Experience: Not Required|

Not Disclosed

Job Description

Roles and responsibilities of this job

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.

Job Specification

Required qualifications for this job

Required Education Level:Under Graduate (Bachelor)

Required Experience:Not Required

Salary

Offered financial and non-financial compensation for this job

Offered Salary:Not Disclosed

Applying Procedure

Click on Login to Apply to get the email address / external link to apply.

Note: You need to be a registered jobseeker to view the applying email address / external link.

Apply Before: May 06, 2024

About the organization

Cedar Gate Services

Software Companies

Kathmandu

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 700+ professionals in our Sanepa office.

Our Vision

We believe that value-based care is revolutionizing the way healthcare is delivered and paid for in the United States, and our mission is to use the power of our technology platform to lead its transformation.

Our Mission

We strive to be the most trusted and comprehensive technology platform to enable the healthcare industry’s success in value-based care.

For more information, visit company website at https://cedargate.com/ and follow our FB page at https://www.facebook.com/CGTNepal

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