Pre-Certification Specialist

CharterCARE of Rhode Island; Providence (RI); On-site; USD 42,000 - 52,000; Full time

Job summary

CharterCARE Roger Williams Medical Center in Providence, RI seeks an Administrative Support Specialist to verify insurance coverage and obtain authorizations for treatments in the Cancer Center/Infusion Suites.

You will enter and track preauthorizations, verify patient benefits, and understand Medicare, Medicaid, and commercial payer guidelines. High school diploma required; associate degree preferred; 2–3 years of insurance verification experience.

Qualifications

• High School Diploma or GED required.
• Associate degree preferred.
• Knowledge of CPT, ICD-10 coding and J codes.
• Knowledge of insurance coverage and reimbursement practices.
• 2–3 years of insurance verification and preauthorization experience in healthcare.

Responsibilities

• Obtain all required authorizations prior to treatments in Cancer Center/Infusion Suites.
• Verify patient insurance coverage, benefits and out-of-pocket responsibilities.
• Enter and track all authorizations and pre-certs as required by payers.
• Understand Medicare, Medicaid and commercial payer guidelines.

Skills

Verbal communication

Written communication

Independent work

Teamwork

Organization

Detail oriented

Learning new software

Persistence in follow-up

Education

High School Diploma or GED

Associate degree preferred

CPT/ICD-10 knowledge

Insurance reimbursement knowledge

Tools

Microsoft Office

Job description

CharterCARE Roger Williams Medical Center 7080-Cancer Center Providence , RI

Administrative support workers Full Time regular (64-80 hrs) , 1st Shift , 8:00 am - 4:30 pm

Summary: Responsible to obtain all required authorizations prior to treatments being performed in the Cancer Center/Infusion Suites, including verification of patient insurance coverage, benefit levels and out of pocket responsibilities. Responsible to obtain, enter, and track all authorizations and pre-certs as required by the individual insurance company. The specialist will be familiar with and understand Medicare, Medicaid, other government payers, Commercial and HMO/PPO Payers guidelines and principals.

Education: High School Graduate or GED required. Associate’s level degree preferred. Knowledge of CPT, ICD 10 coding and J Codes. Knowledge of insurance coverage’s and reimbursement practices.

Experience: Prior experience working in a related role in a medical office or other health care related organization. 2-3 years of prior insurance verification and preauthorization work or related experience in a health care environment.

Skills and Abilities:

• Strong verbal and written communication skills
• Ability to work both independently and as a member of a team
• Ability to remain organized and detail oriented while working at a fast past
• Ability to work independently as well as to function effectively and collaboratively in a team environment.
• Advanced organization skills and ability to handle multiple tasks.
• Proficient with computer applications, a thorough understanding of Microsoft Office suite, internet usage and the ability to learn and master other computer technology / software programs as needed.
• Excellent follow-through and persistence when communicating with patients and members of our community participating in our programs.