Pre-Certification Specialist

Paycom; Lafayette (LA); On-site; USD 37,000 - 52,000; Full time

Job summary

Paycom in Lafayette, LA seeks a PRE-cert Specialist to manage prior authorizations and ensure accurate billing and coding in a fast-paced medical practice. The role requires strong knowledge of CPT/ICD-10 and effective insurer/patient communications.

Candidates should have at least two years of medical office experience, familiarity with EMR/EHR systems, and the ability to work autonomously under supervision. HIPAA-compliant handling of records is essential.

Qualifications

• High School Diploma or equivalent.
• Certified CMA/MOA/Billing and Coding preferred.
• Minimum two years’ experience in the medical field or physician office practice preferred.
• Pass a basic background check for criminal history, drug screening & OIG exclusions.

Responsibilities

• Obtain and maintain prior authorizations from insurance companies regarding procedures both in-office and outlying facilities as well as medications or testing ordered by the providers.
• Collaborates with providers, clinical staff, and others to timely resolve any authorization gaps identified.
• Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date.
• Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.
• VA authorization numbers and follow ups
• Checks the patient’s insurance benefits and determines the amount owed prior to the procedure.
• Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided as needed.
• Any other duties deemed necessary by the Clinical Director.

Skills

Medical billing & coding knowledge

Insurance verification

Effective communication

Education

High School Diploma or Equivalent

Tools

EMR/EHR systems

Job description

PRE-cert SpecialistQUALIFICATIONS:High School Diploma or Equivalent.Certified as a CMA/MOA/Billing and Coding is preferred.A minimum of two (2) years’ experience in the medical field or physician office practice is preferred.Needs to pass a basic background check for criminal history, drug screening & OIG exclusions.ROLE AND RESPONSBILITIES:Obtain and maintain prior authorizations from insurance companies regarding procedures both in-office and outlying facilities as well as medications or testing ordered by the providers.Collaborates with providers, clinical staff, and others to timely resolve any authorization gaps identified.Ensure clinical information submitted for peer review and entered into patient’s electronic record is the most accurate and up to date.Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order.VA authorization numbers and follow upsChecks the patient's insurance benefits and determines the amount owed prior to the procedure.Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided as needed.Any other duties deemed necessary by the Clinical DirectorOTHER BASIC SKILLSSolid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits, in addition to medical terminology.Ability to communicate and interact effectively and professionally with patients, coworkers, and other practice customers.Ability to work autonomously with minimal supervision on assigned tasks as well as accept direction and real time coaching on given task.Ability to prioritize in a fast-paced environment.Maintains the medical record, ensuring confidentiality and accuracy in accordance with organization standards and HIPAA laws.