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.