CEENTA
Precertification Specialist
CEENTA, Huntersville, North Carolina, United States, 28078
Primary Objective
Responsible for the verification of insurance benefits and obtaining prior authorizations for all scheduled procedures as needed by successfully performing duties within the policy and procedures outlined.
Essential Functions
Obtain and confirm insurance benefits via online or telephone
Obtain prior approvals as required by payer plan with regular follow-up as needed
Communicate detailed policy benefits and expected pre-payments to patients
Communicate with provider offices as needed
Prioritize work queue into date of service order and or specific payer and or procedural needs
Ability to meet the physical and mental demands of the position
The ability to work on-site
Predictable, reliable, and prompt attendance
Skills and Abilities
Understanding of payer medical policy and guidelines pertaining to prior authorization requirements
Detailed oriented
Excellent customer service skills; communicating clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
Computer skills including Excel, Word and internet use
Core Competencies
Attention to Detail
Multi-Tasking & Adaptability
Critical Thinking
Follow up
Clinical Competencies
N/A
Training Period
90 days of training within the EMR system, major insurance websites, OnBase Scanning system and Assurance
Accountability
Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.
Education
High school diploma or GED
Experience
2 years of medical field experience
At least 1 year of pre-certification experience preferred
Certificates, Licenses, Registrations
N/A
Work Environment
The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is remote, so employee should have discipline to work alone and a have dedicated workspace with highspeed internet which offers HIPAA compliance and room for two monitors.
Supervisory Responsibilities
N/A
Position Type and Expected Hours of Work
Full-time position, Monday through Friday. The hours may range between 7:00a.m. and 6:00p.m.
Physical and Mental Requirements
The physical and mental demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands: Sitting and working on a computer for extended periods of time. Ability to wear a headset for telephone usage and team meetings
Mental Demands: Ability to work alone, problem solve and work at a high pace.
Travel
Travel is not required for this position, except when training.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to ad or change the essential job functions of this position at any time without notice.
A Typical Day in the Position
The Precertification Specialist is responsible for obtaining prior authorizations for all scheduled surgical, DME, allergy and radiology orders by successfully completing the approved authorization process for all payers. Typical responsibilities include but are not limited to: monitoring assigned work queues, contacting payers, contacting patients about any pre-service payments, address emails/in-baskets, address voicemails, scanned faxes, communicate as needed with provider offices. The Pre-certification specialist should be able to work independently and solve routine type issues, but when potential systemic issues are noted, these should be reported to the Precertification Team Supervisor.
Powered by JazzHR
Responsible for the verification of insurance benefits and obtaining prior authorizations for all scheduled procedures as needed by successfully performing duties within the policy and procedures outlined.
Essential Functions
Obtain and confirm insurance benefits via online or telephone
Obtain prior approvals as required by payer plan with regular follow-up as needed
Communicate detailed policy benefits and expected pre-payments to patients
Communicate with provider offices as needed
Prioritize work queue into date of service order and or specific payer and or procedural needs
Ability to meet the physical and mental demands of the position
The ability to work on-site
Predictable, reliable, and prompt attendance
Skills and Abilities
Understanding of payer medical policy and guidelines pertaining to prior authorization requirements
Detailed oriented
Excellent customer service skills; communicating clearly and effectively
Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
Computer skills including Excel, Word and internet use
Core Competencies
Attention to Detail
Multi-Tasking & Adaptability
Critical Thinking
Follow up
Clinical Competencies
N/A
Training Period
90 days of training within the EMR system, major insurance websites, OnBase Scanning system and Assurance
Accountability
Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.
Education
High school diploma or GED
Experience
2 years of medical field experience
At least 1 year of pre-certification experience preferred
Certificates, Licenses, Registrations
N/A
Work Environment
The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is remote, so employee should have discipline to work alone and a have dedicated workspace with highspeed internet which offers HIPAA compliance and room for two monitors.
Supervisory Responsibilities
N/A
Position Type and Expected Hours of Work
Full-time position, Monday through Friday. The hours may range between 7:00a.m. and 6:00p.m.
Physical and Mental Requirements
The physical and mental demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands: Sitting and working on a computer for extended periods of time. Ability to wear a headset for telephone usage and team meetings
Mental Demands: Ability to work alone, problem solve and work at a high pace.
Travel
Travel is not required for this position, except when training.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to ad or change the essential job functions of this position at any time without notice.
A Typical Day in the Position
The Precertification Specialist is responsible for obtaining prior authorizations for all scheduled surgical, DME, allergy and radiology orders by successfully completing the approved authorization process for all payers. Typical responsibilities include but are not limited to: monitoring assigned work queues, contacting payers, contacting patients about any pre-service payments, address emails/in-baskets, address voicemails, scanned faxes, communicate as needed with provider offices. The Pre-certification specialist should be able to work independently and solve routine type issues, but when potential systemic issues are noted, these should be reported to the Precertification Team Supervisor.
Powered by JazzHR