Pre-Certification Specialist

Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company.

The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals.

Education

High School Graduate or GED required. Associate#s level degree preferred. Knowledge of CPT, ICD 10 coding and J Codes. Knowledge of insurance coverage#s and reimbursement practices. Experience: Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment.

Skills and Abilities: # Strong verbal and written communication skills # Strong computer skills # Ability to work both independently and as a member of a team # Ability to remain organized and detail oriented while working at a fast past # Ability to work independently as well as to function effectively and collaboratively in a team environment.

Advanced organization skills and ability to handle multiple tasks. # Proficient with computer applications, a thorough understanding of Microsoft Office suite, internet usage and the ability to learn and master other computer technology / software programs as needed. # Excellent follow-through and persistence when communicating with patients and members of our community participating in our programs.