Pre-Certification & Authorization Coordinator

Tufts Corporate; Burlington (MA, VT); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading company in healthcare is seeking an entry-level candidate to support revenue cycle operations and Patient Access duties. The role involves billing, collections, and managing patient information, suitable for those with minimal prior experience. Candidates will work under supervision, ensuring efficient scheduling and financial clearance processes. Strong communication and organizational skills are essential, alongside a willingness to learn and adapt in a collaborative environment.

Qualifications

• 2 years of related experience in healthcare or financial services.
• Knowledge of insurance and precertification requirements.

Responsibilities

• Verify insurance benefits and update patient information in EMR.
• Coordinate benefits with multiple insurance carriers.
• Monitor workflow productivity and quality.

Skills

Medical Terminology

ICD-10

CPT Coding

Communication

Organizational Skills

Interpersonal Skills

Customer Service Orientation

Tools

MS Word

MS Excel

Job description

United States, Massachusetts, Burlington

Hours: 40 hours per week; Monday through Friday from 8-4:30 PM (EST)

Location: Remote

Job Profile Summary

This role involves activities related to revenue cycle operations such as billing, collections, and payment processing. Additionally, it includes performing Patient Access duties: handling administrative and financial-clearance tasks to facilitate clinical services procurement. Responsibilities include collecting demographic and financial information from patients or providers, scheduling services, and managing referrals to ensure patients are scheduled for appointments or procedures. This position supports daily business activities in a hands-on environment, typically under supervision, and is suitable for entry-level candidates with minimal prior experience, following routine procedures.

Job Overview

This role emphasizes revenue cycle activities including billing, collections, cost estimates, and payment processing, along with Patient Access duties such as collecting patient information, scheduling, and referral management. It supports organizational operations in a support or clerical capacity, primarily under supervision, and is suitable for entry-level candidates.

Job Description

Minimum Qualifications:

2 years of related experience in a hospital, physician office, or financial services.

Preferred Qualifications:

5 years of related experience in a hospital, physician office, or financial services.

Duties and Responsibilities: The following are general responsibilities and may include other duties:

1. Verify insurance and workers' compensation benefits, entering information into the electronic medical record system.
2. Update patient demographic and financial information, ensuring timely updates in EMR.
3. Obtain financial data from various sources, utilizing computer systems and payer sites.
4. Coordinate benefits when multiple insurance carriers are involved.
5. Secure administrative approval for services by providing necessary clinical data to payers and documenting in hospital systems.
6. Identify services not covered by insurance policies.
7. Communicate financial risks to relevant departments and leadership.
8. Collaborate with financial and pre-registration teams on financial risk concerns prior to services.
9. Gather and submit required clinical documentation for insurance approval.
10. Monitor case statuses, documenting updates promptly.
11. Identify denied claims and work with teams on appeals.
12. Monitor workflow productivity and quality, aiming to meet set goals.
13. Serve as a resource on precertification policies and account resolution, including documentation for appeals.
14. Maintain positive team relationships and contribute to a collaborative work environment.
15. Coordinate with Case Management and Admitting teams on care level changes and communicate with payers accordingly.
16. Adapt to workflow updates and assist in training new team members.

Physical Requirements

• Sitting frequently, standing and walking occasionally, lifting 5-10 lbs.
• Valid driver's license required for local travel.
• Intense mental involvement with multiple projects.
• Manual dexterity for operating computer equipment.
• Ability to see computer screens and reports.

Skills & Abilities

• Knowledge of medical terminology, ICD-10, and CPT coding.
• Understanding of insurance and precertification requirements.
• Willingness to learn computer systems (MS Word/Excel).
• Strong communication, organizational, and interpersonal skills.
• Ability to prioritize, adapt to changes, and work independently or in teams.
• High tact and customer service orientation.
• Understanding of healthcare delivery and referral processes.

Tufts Medicine is committed to diversity and inclusion and provides reasonable accommodations for individuals with disabilities. Contact us at [e-mail] for assistance.