Pre-Certification Specialist

GI ALLIANCE; Littleton (CO); On-site; USD 38,000 - 54,000; Full time

Job summary

Paycom in Colorado is seeking a detail-oriented front office coordinator to support surgery scheduling, radiology referrals, and billing workflows. You will verify insurance referrals, obtain pre-authorizations, and maintain accurate patient demographics in the EMR.

The role requires strong organizational and communication skills, experience with insurance authorizations preferred, and the ability to coordinate with physicians, staff, and patients to ensure appointments run smoothly.

Qualifications

• High school diploma or GED required.
• Strong organizational and communication skills.
• Experience with insurance pre-authorizations preferred.
• Knowledge of medical terminology helpful.

Responsibilities

• Coordinate referrals and pre-authorizations for appointments.
• Enter demographic and insurance data accurately in EMR.
• Calculate and communicate estimated patient responsibility.
• Pull daily reports to ensure authorizations are complete before patient arrival.
• Maintain documentation of authorizations and referrals.
• Communicate with office staff about urgent referrals and pre-auths.
• Reach out to PCPs to obtain referrals and pre-auths.

Skills

Organizational skills

Written communication

Computer skills

Education

High school diploma or GED

Tools

EMR

Patient management system

Job description

Position Summary:Works with surgery scheduling, front office staff, radiology scheduling and billing to ensure that insurance referrals are in place and correct with appropriate visits available. Contacts insurance carriers for pre-authorizations of procedure and medications and ensures that required approvals are obtained prior to patient visit. Responsible for accurate data entry of patient demographics and documentation of all pre-authorizations. Responsible for calculating estimated patient responsibility for procedures and medication. Ensures that all details of the visit are communicated to the patient including estimated cost when appropriate so that upon arrival the appointment can go as scheduled. You are second in command to the manager and will serve as the point of contact should the manager be unavailable or out of the office.Qualifications:High school degree or GED requiredComputer skills required.Strong organization skills.Strong communications skills, both oral and written.Insurance authorizations experience preferredSome medical terminology knowledgeContacts:Interacts with all levels of the URA and Anova business organization, insurance carriers and patientsJob Responsibilities:Have excellent understanding of all protocols regarding referrals and pre-authorizations as designated by the departments. Exceptional attention to detailKnowledge. Understanding of all appointment typesPulls reports daily to ensure that patient referrals and authorizations are completed prior to patient arrival.Maintain standard 2 weeks ahead of appointment date for all pre-auths and referralsMaintain/recheck documentation and scan completed authorizations and pre-auths in EMR.Enters authorizations information, including estimated cost and authorization status, into notes in the patient management system and EMR.Reply to all inter-office email requesting authorizations and referralsCommunication with office and nursing staff upon completion of urgent/ stat referral/preauths.Request referrals from PCP’s for new and establish patients and link to apptsObtain pre auth’s per the standard work listContact patient with estimated cost prior to appointment and document in PM.Follow up on any outstanding pre-auths and referralsIf claim denies for no authorization or referral you will be required to get a retro or appeal with insuranceEnsure that HIPAA regulations are followed at all times.Enter all demographic and insurance information accurately and completely.You are a team and must work cooperatively with your co-workers.Under the supervision of the manager, work with coworkers to ensure daily completion of responsibilities, assigning tasks as needed.Assist manager with additional tasks as delegated.Physical RequirementsManual DexterityRequired to perform gross body coordination such as walking, stooping, and standing while performing tasks, carrying and lifting objects. Required to perform simple motor skills and manipulative skills such as typing and writing.MobilityRequired to sit for long periods of time.Required to walk and stand (including for long periods of time).Visual DiscriminationRequired to read computer screen.HearingRequired to hear normal sounds with some background noise when answering phones.Mental Requirements:Able to process great amounts of information, apply problem solving skills and exercise good judgment. Ability to multi-task.