The Pre-Certification Specialist monitors appropriateness and medical necessity, and provides necessary information for authorization and continued visits. This person will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed.
SKILLS AND ABILITIES:
1. Detail orientated
2. Self-motivated and ability to work effectively in an independent environment.
3. Strong communication and organizational skills.
4. Working knowledge of medical billing and managed care.
5. Ability to work in a fast paced environment.
1. Reviewing information for continued visits management including type and duration of service, authorization and treatment codes, re-authorization and continued visit requirements necessary for ongoing treatment.
2. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
3. Responsible for tracking, obtaining, and extending authorizations from various carries in a timely manner.
4. Verify receipt of all necessary pre-authorization documents prior to the procedure.
1. Knowledge of medical terminology.
2. Familiarity with different insurance types.
3. 1 year of pre-certification experience preferred.