Healthcare 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 on a Work in the office set-up.

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 in eviCore or another Insurance Portal as required.

• Request additional clinicals as needed.

• Review clinicals received and ensure it meets insurance clinical guidelines for authorization.

• Monitoring of pending cases for approval or denials

• Make necessary follow-ups on insurance, clinics on pending/denied cases.

• Take action on pending cases if it requires additional clinicals, CPT recommendations, and among 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