Pre-Certification Representative

Med-Metrix; Chennai District; On-site; INR 360,000 - 480,000; Full time

Job summary

Med-Metrix is seeking a Pre-Certification Representative to obtain accurate precertification data from insurance companies and input it into our systems. You will call health plans, interpret clinical information for insurers, and maintain patient data with strict confidentiality.

The role requires healthcare experience, knowledge of CPT codes and medical terminology, and strong communication and organizational skills. A HIPAA-compliant, team-oriented environment is offered.

Qualifications

• High school diploma or equivalent required.
• Healthcare/pre-authorizations experience 2–3 years preferred.
• Knowledge of payor websites (eviCore/Navinet/Novitasphere).
• Familiarity with CPT codes, modifiers and diagnosis codes.
• Strong communication and organizational skills; HIPAA aware.

Responsibilities

• Obtain pre-certifications from insurance companies before services.
• Place calls to health plans to secure precertifications.
• Interpret clinical information and relay to insurers.
• Input and maintain patient data in scheduling systems accurately.
• Verify insurance information and document in systems.
• Review claim denials and communicate resolutions.
• Maintain confidentiality and HIPAA compliance in all tasks.
• Collaborate with physician offices and patients as needed.

Skills

Medical terminology

CPT codes

Modifiers and diagnosis codes

Strong communication skills

Organizational skills

Teamwork / works well in a team

Independent work capability

Proficiency in Microsoft Office Suite

PHI handling awareness (HIPAA)

Education

High School diploma or equivalent

Tools

GE Centricity

EPIC PB

eviCore

Navinet

Novitasphere

Job description

Job Purpose

The Pre-Certification Representative is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies.

Duties And Responsibilities

• Works effectively with insurance companies to obtain pre-certification for services
• Places calls to various health plans to obtain appropriate precertification prior to the patient’s appointment
• Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
• Faxes pre-certification request form to insurance company
• Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
• Verifies medical insurance information and documents in scheduling/registration modules
• Reviews claim denials and rejections
• Accurately enters and updates patient data, and other general data, into the computer system
• Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
• Demonstrates knowledge of varied managed care insurance and regulatory guidelines
• Meets and maintains daily productivity/quality standards established in departmental policies
• Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts
• Adheres to the policies and procedures established for the client/team
• Communicates effectively with physician offices and patients
• Places outbound call to patients with precertification notification
• Works independently from assigned work queues
• Maintains confidentiality at all times
• Maintains a professional attitude
• Other duties as assigned by the management team
• Uses, protects and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understands and complies with Information Security and HIPAA policies and procedures at all times
• Limits viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• High School diploma or equivalent required
• Medical terminology knowledge required
• Minimum of 2-3 years of healthcare or physician’s office related experience in obtaining and handling pre-authorizations
• Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
• Ability to work well individually and in a team environment
• Strong organizational and task prioritization skills
• Experience with GE Centricity or EPIC PB preferred
• Strong communication skills/oral and written
• Strong organizational skills
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem‑solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must possess a smart‑phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.