Precertification Specialist

2 weeks ago

Jamaica, United States NavitsPartners Full time
Job DescriptionJob Description

Position: Precertification Specialist
Location: Flushing, NY
Duration: 2 Months

Shift:

9:00 am - 5:00 pm (includes a 60-minute break)

Department:

OBGYN - 207245

Job Summary:

The Precertification Specialist is responsible for managing the precertification process for OB/GYN ultrasounds and related procedures. This role ensures all necessary insurance pre-authorizations are obtained in a timely and efficient manner, contributing to smooth patient care and administrative operations at NYP Queens.

Essential Job Functions:

  1. Precertification and Authorization:

    • Obtain insurance precertification for OB/GYN ultrasounds and other related procedures.
    • Utilize knowledge of CPT codes and medical terminology specific to OB/GYN services.

  2. Insurance Verification:

    • Verify patient insurance coverage and benefits.
    • Communicate with insurance companies to confirm patient eligibility and coverage details.

  3. Patient Coordination:

    • Coordinate with patients to collect necessary information for insurance verification and precertification.
    • Inform patients of their insurance status and any necessary steps they need to take.

  4. Documentation and Record-Keeping:

    • Accurately document all interactions and transactions related to precertification and insurance verification in the Electronic Health Record (EHR) system.
    • Ensure compliance with all relevant regulations and policies.

  5. Use of EHR Systems:

    • Proficiently use EPIC and other EHR systems to manage patient records and insurance information.
    • Maintain up-to-date knowledge of EHR functionalities and updates.

  6. Interdepartmental Coordination:

    • Work closely with medical, administrative, and billing departments to ensure seamless patient care and service delivery.
    • Communicate effectively with healthcare providers to resolve any issues related to precertification.

  7. Human Relationship Skills:

    • Demonstrate strong interpersonal skills in interactions with patients, families, insurance representatives, and healthcare team members.
    • Address and resolve patient concerns related to insurance coverage and precertification.

  8. Additional Duties:

    • Perform other duties and projects as assigned by the department supervisor.
Required Skills & Experience:
  • Education:
    • High School Diploma (Required).
  • Experience:
    • Minimum of 2+ years of job-related experience, particularly in a healthcare setting.
    • Experience with insurance verification and obtaining insurance precertification.
    • Proficiency in using EPIC or similar Electronic Health Record systems (Required).
  • Skills:
    • Strong knowledge of OB/GYN ultrasound procedures and CPT codes.
    • Excellent human relationship and communication skills.
    • Ability to manage multiple tasks and prioritize effectively.