Pre-Certification Specialist

Prospect Medical Holdings, Inc.; Providence (RI); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Insurance Verification Specialist to join their team. This role is crucial for ensuring that all required authorizations are obtained prior to treatments in the Cancer Center/Infusion Suites. The ideal candidate will have a strong background in insurance verification and preauthorization, with a solid understanding of Medicare, Medicaid, and commercial payer guidelines. By joining this forward-thinking organization, you'll be part of a team that prioritizes patient care and employee development, making a meaningful impact in the community. If you are passionate about advancing your career in healthcare while providing exceptional service, this opportunity is perfect for you.

Qualifications

• 2-3 years of experience in insurance verification and preauthorization in healthcare.
• Familiarity with Medicare, Medicaid, and commercial insurance guidelines.

Responsibilities

• Obtain and track authorizations for treatments in the Cancer Center.
• Verify patient insurance coverage and out-of-pocket responsibilities.

Skills

Insurance Verification

Preauthorization

Knowledge of Medicare and Medicaid

Communication Skills

Education

High School Graduate or GED

Associate's Degree

Job description

Prospect CharterCARE Roger Williams Medical Center, LLC

Full Time regular (64-80 hrs)

Hours/Pay Period: 64

Summary

Responsible for obtaining 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 for obtaining, entering, and tracking 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, and Commercial and HMO/PPO Payers guidelines and principles.

Education

High school graduate or GED required. Associate's level degree preferred.

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.

TOGETHER we are CharterCARE

Putting people first, it's what we do with our patients and our employees. At CharterCARE Health Partners, we believe in and support our employees, the heart of our organization. Created through the affiliation of Roger Williams Medical Center, Blackstone Valley Surgicare, and St. Joseph Health Services of Rhode Island (Our Lady of Fatima Hospital and St Joseph Health Clinic), CharterCARE was formed to preserve and enhance quality health care for the communities we serve.

If you are looking to partner with an organization that is as committed to advancing your career goals as it is to providing superior medical care, we invite you to review our open positions today. We look forward to meeting you.