Precertification Specialist

HVC; Alpharetta (GA); Hybride; USD 45 000 - 60 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Short/Long term disability

401k

PTO

Life insurance

Critical illness

Hospital indemnity

Holiday pay

Résumé du poste

Heart and Vascular Care seeks a Precertification Specialist for a hybrid remote role. The position combines 4 days remote work with 1 day in our Alpharetta office after training in our regional center.

Training is 2–4 weeks Monday–Friday in Alpharetta, with duties including benefit verification, ICD-10/CPT coding for authorization, and patient education on billing and responsibilities. Prior medical experience and strong attention to detail are required.

Qualifications

• Proven precertification experience with insurance benefits.
• Ability to interpret benefit plans and explain them to patients.
• Prior medical experience and compliance awareness.

Responsabilités

• Obtain complete and accurate insurance information and verify benefits.
• Use ICD-10 and CPT codes to obtain proper authorizations.
• Explain benefits and financial responsibilities to patients.
• Ensure treatment is medically necessary per payer guidelines.
• Document authorizations and related communications accurately.
• Utilize payer portals and maintain HIPAA-compliant records.
• Review denials and process appeals in a timely manner.
• Provide up-to-date clinical information to insurance representatives per HIPAA.

Connaissances

Medical precertification

HIPAA compliance

Outils

Payer portals

ICD-10 codes

CPT codes

Description du poste

We are hiring a Precertification Specialist for an exciting opportunity to join our growing team!

• To be considered for this position, you must have medical insurance precertification experience. While we will train you on our processes, we expect you to have the basic medical precertification skills already.

Benefits:

Medical, dental, vision, short/long term disability, 401k, PTO, life insurance, critical illness, hospital indemnity, and holiday pay.

Hours:

Monday-Friday, 8AM - 5PM, no nights or weekends

This is a HYBRID REMOTE Position - work schedule (4 days remote / 1 day in office in Alpharetta) - after training.

Training is 2 - 4 weeks M-F (8a - 5p) in our Regional Support Office in Alpharetta

Duties may include but not limited to:

• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential issues.
• Utilize ICD-10 and CPT codes to ensure proper authorization for procedure and claims payment.
• Responsible for explaining benefits, the billing process and financial responsibilities to patients.
• Responsible for ensuring treatment is medically necessary, align with established standards, payer guidelines and are approved within the required timeframe.
• Maintain accurate documentation of authorization and other related information.
• Utilization of payer portals
• Record all communication with providers and personnel in standardized documentation and proper format
• Review denial reasons and follow the appeal process in a timely manner. Arrange peer to peer, if applicable.
• Provides detailed, accurate and current clinical information to insurance representatives complying with HIPAA regulations.

Requirements:

• Dependable team player is a must.
• Ability to work in a fast paced environment.
• Prior medical experience is required.

Heart and Vascular Care is a cardiology practice that places a priority on compassionate patient care and service. In our team-based and family-oriented setting, we strive to set a new bar for patient healthcare through a modern, friendly, and thoughtful approach.