Pre-Certification Specialist

3 weeks ago

Houston, United States Medix Full time
Job DescriptionJob Description

Medix's RCM client is looking for an experience Pre-Certification Specialist Apply if qualified and interested

Positions: Pre-Certification Specialist
Expected 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 role
Start 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 country

  • Career growth opportunity

  • Hybrid work

Must Have Skills

  • 2 years of Pre-Certification experience
  • VBC or bundling verification experience is preferred
  • Great if they come from a value based care company, but it is not required
  • Working 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 skills
  • Problem-solving
  • Ability to perform multiple tasks simultaneously and problem-solve efficiently
  • Excellent organizational and interpersonal skills
  • Strong desire to learn and utilize technology effectively

Dress 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.

Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r
\r
Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

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