Pre-Certification Specialist

Paycom; Beaumont (TX); On-site; USD 35,000 - 50,000; Full time

Job summary

Paycom in Beaumont, TX is seeking a Pre-Certification Specialist responsible for obtaining precertification and prior authorization from insurance companies for patient appointments and procedures, and recording data in the practice management system.

The role requires at least two years of pre-certification experience, a high school diploma or GED, and knowledge of ICD-10 and CPT-4 codes, with strong communication, multi-tasking, and ethical standards.

Qualifications

• Minimum two years of pre-certification experience.
• High School diploma or GED.
• Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.

Responsibilities

• Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.
• Contact insurance companies as needed to obtain precertification and record on form data entry.
• Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.
• Documents, within the practice management system, all required information to include financial responsibility.
• Verify waivers have been signed as needed for tests and procedures prior to date of service.
• Light data entry and other related office duties.

Skills

Excellent communication skills

Proficient computer skills

Multi-tasking and prioritization

Self-motivation and initiative

Strong ethics

Attention to detail

Education

High School diploma or GED

Tools

Practice management system

Job description

Position purposeResponsible for the communicating with insurance companies to ensure proper certification/authorization is obtained prior to patient’s appointment and all scheduled tests and procedures.Responsibilities/Duties/Functions/Tasks:Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Obtain all requests for precertification and prior authorization from insurance companies for appointments, scheduled tests and procedures.Contact insurance companies as needed to obtain precertification and record on form data entry.Communicates necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.Documents, within the practice management system, all required information to include financial responsibility.Verify waivers have been signed as needed for tests and procedures prior to date of service.Communicate with staff on any adjustments on precertification.Light data entry and other related office duties.Other duties as assigned.QualificationsEducation: High School diploma or GED.Experience: Minimum of two (2) years of pre-certification experience required.Requirements for Level I Status:Entry level (1-4 years’ experience) and/or meet the basic requirements of the job with the need for additional supervision.Excess of 4 years’ experience if meeting only the basic requirements of the job with need for additional supervision.Additional Qualifications: Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.Performance Requirements:Excellent communication skills, both written and verbal.Proficient technical (computer) skills.Ability to multi-task and prioritize.Self-motivated with initiative.Strong sense of ethics.