Job Summary:

The Precertification Specialist acts as liaison between payers and healthcare providers, verifying patient insurance eligibility and benefits as well as obtaining precertifications (authorizations) for all specified procedural orders. [Extensive training will be provided for this entry-level position, and candidates without any experience are also encouraged to apply.]

Responsibilities:

• Verifies patient insurance eligibility and benefits for specified services.
• Captures patient demographic, eligibility, and benefits information within applicable software systems.
• Obtains and documents precertification numbers from insurance companies prior to specified services per protocol.
• Obtains and documents referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
• Distributes organization inpatient and outpatient service lists and manifests to affiliated healthcare providers.
• Corrects any account in which errors have occurred per assigned deadline.
• Maintains communication among healthcare providers, insurance companies, and organization regarding status of patient eligibility, benefits, and precertifications.
• Meets all department accuracy and productivity standards.
• Maintains appropriate records for area(s) of responsibility.
• Maintains confidentiality of all information in accordance with HIPAA. 
• Maintains company confidentiality.
• Attends all regular staff meetings.
• Participates in continuing training to keep current on area of specialty.
• Works overtime as needed.
• Completes additional duties and projects as assigned by management.