Medical Precertification Specialist

5 days ago


Princeton, New Jersey, United States Princeton Medical Group Inc Full time
About Us

Princeton Medical Group Inc. is a private medical practice with over 30 providers and 8 medical specialties. Our mission is to deliver exceptional medical care with compassion.

Job Summary

We are seeking a highly skilled Medical Precertification Specialist to join our dynamic team. As a key member of our clinical operations, you will be responsible for obtaining precertifications for testing and procedures, communicating with nursing staff, and staying up-to-date on insurance company requirements and guidelines.

Responsibilities
  • Obtain precertifications for testing and procedures in a timely and accurate manner.
  • Communicate effectively with nursing staff to ensure seamless patient care.
  • Stay actively informed about changes in insurance company requirements and guidelines.
  • Use manual and computerized systems to obtain precertifications.
  • Track appeals for denied requests to insurance companies.
  • Complete follow-up tasks related to active and pending reviews.
  • Coordinate peer-to-peer sessions as needed.
  • Establish and maintain logs to ensure historical patient and office activities are available for review.
  • Adhere to strict confidentiality guidelines.
Requirements
  • Previous experience in precertification or a related field.
  • Excellent customer service skills for dealing with internal and external customers.
  • Knowledge of insurance and precertification processes.
  • Knowledge of medical terminology and the ability to interpret medical charts.
  • 1 year of experience with ICD-10 billing processes (preferred).
Work Environment

This is a full-time position in a medical office setting. The ideal candidate will have excellent communication and organizational skills, with the ability to work in a fast-paced environment.

Benefits

Princeton Medical Group Inc. offers a comprehensive benefits package, including personal medical and dental insurance, 401(k) and profit-sharing plan, life insurance, and paid time off.



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