Pre-Certification Specialist: Healthcare Authorizations

Med--metrix; Aberdeen (WA); On-site; USD 25,000 - 33,000; Full time

Job summary

Med--metrix is seeking a Pre-Certification Representative to obtain accurate precertification data from insurance companies and input it into the client host system, ensuring completeness and data integrity for every case.

You will call health plans to obtain precertifications, verify patient information, relay clinical details to payors, review denials, and maintain PHI confidentiality under HIPAA while supporting scheduling and registration teams with timely updates.

Qualifications

• High School diploma or equivalent required.
• Medical terminology knowledge required.
• 2-3 years of healthcare or physician's office experience in obtaining and handling pre-authorizations.
• Extensive knowledge of payor websites, including eviCore, Navinet and Novitasphere.
• Knowledge of CPT codes, modifiers and diagnosis codes.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office Suite.

Responsibilities

• Works effectively with insurance companies to obtain pre-certification for services.
• Places calls to health plans to obtain precertification prior to the patient’s appointment.
• Interprets clinical information and relays pertinent data to the insurer.
• Faxes pre-certification request forms to insurance companies.
• Maintains confidential information using the client-host system and established procedures.
• Verifies medical insurance information and documents in scheduling/registration modules.
• Reviews claim denials and rejections.
• Enters and updates patient data into the computer system.
• Handles patient intake, insurance verification, and notification of copays.
• Maintains HIPAA compliance and confidentiality at all times.

Skills

Medical terminology knowledge

Strong communication skills

Microsoft Office Suite

Education

High School diploma or equivalent

Tools

eviCore

Navinet

Novitasphere

GE Centricity

EPIC PB

Job description

Med--metrix is seeking a Pre-Certification Representative to obtain accurate precertification data from insurance companies and input it into the client host system, ensuring completeness and data integrity for every case.

You will call health plans to obtain precertifications, verify patient information, relay clinical details to payors, review denials, and maintain PHI confidentiality under HIPAA while supporting scheduling and registration teams with timely updates.