About the job

Position Summary

Reasons You Will Want This Position

•  We are a rapidly growing company with limitless career growth and advancement for top performers 
•  Our culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyone 
•  Work with a team of talented technology professionals who will challenge and help you perform at your best 

Summary

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.

Roles & Responsibilities

•  Call the patient’s insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions 
•  Capture 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 

Required Experience / Qualifications

•  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 

Your Future Working Environment

If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

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