Pre-Certification Specialist

The Cardiac and Vascular Institute of Gainesville, FL seeks to be the provider of choice for cardiovascular care to the people of North Central Florida by combining state of the art comprehensive cardiac services and care with innovative technology. We are seeking a PROCEDURE SCHEDULING AND PRE-CERT SPECIALIST. This position is located in Gainesville zip code 32605.

JOB TITLE: Pre-Certification Specialist

GENERAL SUMMARY OF DUTIES: Verifies insurance and obtains pre-certification authorization for hospital procedures, admissions and testing.

FLSA STATUS: Non-Exempt

ESSENTIAL FUNCTIONS:

• Verifies insurance and obtain authorizations for office based procedures
• Obtain authorizations for hospital procedures/testing/admissions.
• Submit denied authorization requests for Review
• Inform patients of financial obligations regarding co-pays, co-insurances, and deductibles.
• Secure payment arrangements as needed regarding balances on accounts.
• Communicates with practice and hospital staff regarding scheduling and authorization issues.
• Scans/records required documentation regarding procedures, admissions, testing, and referrals.
• Inform patients of financial obligations regarding co-pays, co-insurances, and deductibles.
• Performs courier services to and from hospital as needed.
• Provides Business Office with information needed for proper coding and billing.
• Works collaboratively with, and provides general support and back-up to Cath Lab Coordinator

The job holder must demonstrate current competencies applicable to the job position.

EDUCATION: High School graduate or GED

EXPERIENCE: Minimum 1 year insurance experience in a health care organization or specialty practice, preferably Cardiology-based.

REQUIREMENTS: Proficiency in standard EHR and Practice Management software is desired. Proficiency in medical terminology with emphasis on Cardiology. Working knowledge of insurance guidelines and terminology as well as CPT and ICD-9 coding. Basic knowledge of electronic medical records retrieval system, computers, and the Internet. Perform multiple tasks and meet deadlines. Communicate effectively, efficiently, and professionally. Knowledge of Intergy and Medical Manager systems highly preferred.

KNOWLEDGE:

• Knowledge of basic cardiology and medical coding terms.
• Knowledge of medical terminology.
• Knowledge of insurance industry.

ENVIRONMENTAL / WORKING CONDITIONS: Work is performed in a medical office environment. Frequent contact with physicians and staff as well as extensive phone contact with patients and staff at outlying facilities. Work is stressful at times.

PHYSICAL/MENTAL DEMANDS: Work requires hand dexterity for office machine operation, stooping and bending to files and supplies, and sitting for extended periods of time. Manual dexterity for using a calculator or computer keyboard.