HiringCafe
Posted 1mo ago

Precertification Specialist

@ Heart and Vascular Care
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Alpharetta, Georgia, United States
HybridFull Time
Responsibilities:verifying benefits, interpreting plans, explaining costs
Requirements Summary:Verify insurance benefits, obtain accurate information, interpret plans, use ICD-10/CPT codes, explain benefits, ensure medical necessity, maintain documentation.
Technical Tools Mentioned:ICD-10, CPT, Payer Portals, Electronic Medical Records (EMR)
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Job Description

We are hiring a Precertification Specialist for an exciting opportunity to join our growing team!

Benefits: Medical, dental, vision, short/long term disability, 401k, PTO, life insurance, critical illness, hospital indemnity, and holiday pay.

This will be a hybrid role after 2 to 4 weeks of training. Training is in our Regional Support office M-F from 8-5. After completing training you will work 4 days remote / 1 day at our Regional Support office in Alpharetta.

Hours: Monday-Friday, 8AM - 5PM, no nights or weekends

Duties may include but not limited to:

  • Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential issues.

  • Utilize ICD-10 and CPT codes to ensure proper authorization for procedure and claims payment.

  • Responsible for explaining benefits, the billing process and financial responsibilities to patients.

  • Responsible for ensuring treatment is medically necessary, align with established standards, payer guidelines and are approved within the required timeframe.

  • Maintain accurate documentation of authorization and other related information.

  • Utilization of payer portals

  • Record all communication with providers and personnel in standardized documentation and proper format

  • Review denial reasons and follow the appeal process in a timely manner. Arrange peer to peer, if applicable. 

  • Provides detailed, accurate and current clinical information to insurance representatives complying with HIPAA regulations. 

Requirements:

  • Dependable team player is a must.
  • Ability to work in a fast paced environment.
  • Prior medical experience is required.

Heart and Vascular Care is a cardiology practice that places a priority on compassionate patient care and service. In our team-based and family-oriented setting, we strive to set a new bar for patient healthcare through a modern, friendly, and thoughtful approach.

Come be a part of our growing team. Apply and someone will be in touch!