Medix
Pre-Certification Specialist
Medix, Houston, Texas, United States, 77246
Medix's RCM client is looking for an experience Pre-Certification Specialist! Apply if qualified and interested!
Positions:
Pre-Certification SpecialistExpected Shift/Hours:
Monday through Friday; 8 hours a day/40 hours week
- 3 days onsite; 2 days remote
- Flexible on hours
Expected Duration:
5 months; True Contract to hire roleStart Date:
12/2/2024
Overview
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. Act as liaison between the insurance companies and physician's offices, verify insurance eligibility and benefits, and obtain precertification/ preauthorization for procedures, diagnostic testing, and office visits. Data enter CVCP Authorizations to meet productivity and documentation guidelines.
Duties
Accurately complete all fields in the patient demographic and insurance screens within the computer system.Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test. > Assist patients with scheduling new patient office visits with CVCP provider offices. > Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.Complete all fields within the computer system necessary to process claims and reroute claims to the billing department by the assigned deadline.Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing.Correct any account in which errors have occurred per the assigned deadline. > Communicate constantly between the physician, insurance company, and CVCP regarding patient authorization and CVCP Auth status.Maintain a minimum average of 30 CVCP Authorizations daily with proven accuracy after 3 months.Selling Points
One of the Top TCM companies in the countryCareer growth opportunityHybrid work!Must Have Skills
2 years of Pre-Certification experienceVBC or bundling verification experience is preferredGreat if they come from a value based care company, but it is not requiredWorking knowledge of managed care in all areas, most notably referrals, insurance verification, and precertification.Minimum 40 WPM keyboarding (strong typing skills)Soft Skill/Attribute Requirements
Detail-oriented and robust critical thinking skillsProblem-solvingAbility to perform multiple tasks simultaneously and problem-solve efficientlyExcellent organizational and interpersonal skillsStrong desire to learn and utilize technology effectivelyDress Code
Business Casual
How do you apply?
Click "Apply" OR or email your resume!
Medix is acting as an Employment Business in relation to this vacancy.
Positions:
Pre-Certification SpecialistExpected Shift/Hours:
Monday through Friday; 8 hours a day/40 hours week
- 3 days onsite; 2 days remote
- Flexible on hours
Expected Duration:
5 months; True Contract to hire roleStart Date:
12/2/2024
Overview
The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. Act as liaison between the insurance companies and physician's offices, verify insurance eligibility and benefits, and obtain precertification/ preauthorization for procedures, diagnostic testing, and office visits. Data enter CVCP Authorizations to meet productivity and documentation guidelines.
Duties
Accurately complete all fields in the patient demographic and insurance screens within the computer system.Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test. > Assist patients with scheduling new patient office visits with CVCP provider offices. > Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.Complete all fields within the computer system necessary to process claims and reroute claims to the billing department by the assigned deadline.Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing.Correct any account in which errors have occurred per the assigned deadline. > Communicate constantly between the physician, insurance company, and CVCP regarding patient authorization and CVCP Auth status.Maintain a minimum average of 30 CVCP Authorizations daily with proven accuracy after 3 months.Selling Points
One of the Top TCM companies in the countryCareer growth opportunityHybrid work!Must Have Skills
2 years of Pre-Certification experienceVBC or bundling verification experience is preferredGreat if they come from a value based care company, but it is not requiredWorking knowledge of managed care in all areas, most notably referrals, insurance verification, and precertification.Minimum 40 WPM keyboarding (strong typing skills)Soft Skill/Attribute Requirements
Detail-oriented and robust critical thinking skillsProblem-solvingAbility to perform multiple tasks simultaneously and problem-solve efficientlyExcellent organizational and interpersonal skillsStrong desire to learn and utilize technology effectivelyDress Code
Business Casual
How do you apply?
Click "Apply" OR or email your resume!
Medix is acting as an Employment Business in relation to this vacancy.