Pre-Certification Specialist.

1 month ago

Lake Mary, United States Pyramid Consulting, Inc Full time

Immediate need for a talented Pre-Certification Specialist. This is a 06+months contract opportunity with long-term potential and is located in Lake Mary, FL (Remote). Please review the job description below and contact me ASAP if you are interested.


Job ID:24-50237

Pay Range: $20 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, visiocin), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:


  • Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal.
  • Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate).
  • Determine authorization requirements based on company policy, member benefit grid and provider status.
  • Review customer coverage and benefits.
  • Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse).
  • Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
  • Professional demeanor and the ability to work effectively within a team or independently.
  • Flexible with the ability to shift priorities when required.
  • Maintains regular and acceptable attendance in accordance with Time Away From Work policy.
  • Ability to work evening, weekend and holiday shifts to support the UM Department.
  • Other duties as requested.


Key Requirements and Technology Experience:


  • Key Skills:Medical Terminology, Managed care envrionment, call center
  • Proficient in medical terminology, CPT, HCPCS and ICD-10 coding.
  • Effective oral and written communication skills.
  • Strong customer orientation.
  • Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word.
  • Excellent typing skills.
  • Previous call center/phone queue experience required.
  • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer.
  • Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment.
  • Proficient knowledge of departmental policies and procedures.
  • Knowledge of Medicare Regulatory Requirements.
  • Previous experience working in a remote environment.
  • High School Diploma and preferred 1-2 years’ experience in a managed care environment.


Our client is a leading Healthcare and insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.


Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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