Pre-Certification Specialist

Responsible for collecting and entering complete and accurate demographic and insurance information prior to the patient’s arrival. Verifying that the pre-certification requirements of the insurance companies have been met. Verifying the benefits coverage and quantifying the patient liability portion. Contacting the patient the day before arrival to remind them of the appointment, set the expectation for payment, and answer any questions the patient may have.

FLSA: Non-exempt

EEO: 01 Officials and Managers 02 Professionals 03 Technicians 04 Sales Workers X 05 Administrative Support Workers 06 Craft Workers 07 Operatives 08 Laborers and Helpers 09 Service Workers

Minimum Education
X High school diploma or equivalent X Required

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Certifications:
X HFMA’s Certified Patient Account Representative (CPAR) designation- preferred

Minimum Work Experience
Minimum one (1) year in customer service focused environment.

Computer, data entry experience.

Familiar with Third Party Payers Utilization Management Requirements for Outpatient Procedures.

Must possess an understanding of Medical Terminology and diagnostic procedures.

Previous scheduling or medical diagnostic department experience