Pre Cert Rep

Overview

The Pre-Certification Representative is responsible for obtaining approval from insurance companies for services that require referral, pre-certification or prior authorization. All job functions are performed in a manner that promotes the highest level of compliance with various legal, regulatory and accreditation requirements while maintaining all protected health information in manner that complies with HIPAA requirements.

Qualifications

Education: High School diploma or GED required; post-secondary education preferred.

Experience: Three years of medical insurance or medical billing experience required; One year of prior experience with pre-certifications preferred

Additional Skills/Abilities: Proficiency working with computer applications, including Word, Excel and EMR/Billing systems required. Understanding of medical terminology and general medical billing processes, including accounts receivable required. Basic understanding of medical coding required. Broad understanding of insurance company requirements related to services that require referral, pre-certification or prior authorization required. Ability to process a high volume of work in an accurate manner required. Ability to communicate effectively both verbally and in writing required. Effective work habits including, regular and prompt attendance, dependability, teamwork and initiative required.