About the job Pre-Certification Specialist
Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers.
As a Pre-Certification Specialist you are responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribing and triaging patient calls to physicians, and coordinating patient appointments/orders.
This is a full-time role, on a US shift and in a Work-in-the-office setup.
If you have the right skill set, this may be your opportunity to enter this fast-growing organization.
DUTIES AND RESPONSIBILITIES:
Responsible for day-to-day monitoring of the Radiology Worklist.
Sorting of cases based on priority.
Calling out to Insurance Companies for insurance verification, referrals and auth process.
Case creation is in eviCore or another insurance portal as required.
Request additional clinicals as needed.
Review clinicals received and ensure they meet insurance clinical guidelines for authorization.
Monitoring of pending cases for approval or denials
Make necessary follow-ups on insurance, cand linics on pending/denied cases.
Take action on pending cases if they require additional clinicals, CPT recommendations, and others.
Notification to the provider or medical assistant for pending or denied cases.
Other tasks as given by an immediate superior.
QUALIFICATIONS:
At least 2nd-year level/Graduate/Postgraduate/ Doctorate degree in Life Sciences
With at least 6 months and above experience in obtaining Pre-Authorization in a healthcare environment.
Knowledgeable in CPT codes and DX codes
Familiar with different insurance portals and websites
ESSENTIAL SKILLS:
Good verbal and written communication
Detail Oriented
Good understanding of the Pre-Certification Process