Pre-Certification Specialist

CharterCare Health Partners

Providence, RI

JOB DETAILS
SKILLS
Cancer, Communication Skills, Computer Skills, Computer Software, Current Procedural Terminology (CPT), Detail Oriented, Follow Through, Government, Health Maintenance Organization (HMO), Healthcare, High School Diploma, ICD-10, Insurance, Medicaid, Medical Office, Medicare, Microsoft Office, Multitasking, Organizational Skills, Preferred Provider Organization (PPO), Presentation/Verbal Skills, Reimbursement, Writing Skills
LOCATION
Providence, RI
POSTED
14 days ago

Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals. Education: High School Graduate or GED required. Associates level degree preferred. Knowledge of CPT, ICD 10 coding and J Codes. Knowledge of insurance coverages and reimbursement practices. Experience: Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment. Skills and Abilities: Strong verbal and written communication skills Strong computer skills Ability to work both independently and as a member of a team Ability to remain organized and detail oriented while working at a fast past Ability to work independently as well as to function effectively and collaboratively in a team environment. Advanced organization skills and ability to handle multiple tasks. Proficient with computer applications, a thorough understanding of Microsoft Office suite, internet usage and the ability to learn and master other computer technology / software programs as needed. Excellent follow-through and persistence when communicating with patients and members of our community participating in our programs.

About the Company

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CharterCare Health Partners