Pre-Certification Specialist -

BR Cardiovascular Clinic SUMMARY:

Responsible for obtaining insurance information from referring provider s offices. Verifying benefits for clinical and procedural appointments. Building new patient accounts entering all relevant insurance information. Obtaining prior authorization from commercial, military, workers compensation and motor vehicle insurance companies to ensure appropriate reimbursement. Must have a thorough understanding of the insurance process. Utilizes various avenues to verify coverage and document patient responsibility in each account to ensure correct copay/co insurance amounts are collected at each visit. Must be able to communicate inter-departmentally, with providers offices as well as with insurance companies. Functions as subject matter expert to both internal and external customers.

JOB REQUIREMENTS

Education:

High school diploma or equivalent

Experience:

12 to 18 months related experience and/or training in the healthcare and/or office/clerical and customer service fields.

Other:

Preferred applicant will have a working knowledge of medical insurance including: Medicare, Medicaid, Military, Commercial, Motor Vehicle Accident and Workers Compensation.

Preferred Education:

Associates Degree Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without an accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to perform the following: Must have the ability to communicate effectively, orally and in writing, to solve problems and make decisions. Spend 8 hours or more in front of computer, monitor or similar screen utilizing keyboard and/or mouse, daily. Ability to occasionally stand and walk, occasionally bend, squat and twist, and occasionally lift 20 pounds with proper body mechanics. Spends eight hours or more in front of computer, monitor or similar screen utilizing keyboard and/or mouse. Must have a keen sense of hearing and visual acuity with or without correction. Must be able to handle critical and highly stressful situations with efficiency and composure.

Work Environment :

Office setting, within a hospital environment Position Type and Expected Hours of Work This is a position in a hospital setting which is open 24 hours a day, 365 days a year.

Office staff:

5 days a week, Monday - Friday 8 hour shifts