Job Description

Job Description

Job Description

Job Summary:

The Pre-Certification Representative is responsible for obtaining approval from insurance companies for services that require referral, pre-certification or prior authorization.

Essential Functions

• Maintains patient demographic information and data collection systems.
• Verify insurance eligibility for both medical and vision insurances for upcoming appointments by utilizing online websites or by contacting the carriers directly.
• Review patient deductibles and/or copays and enter into the billing system and spreadsheets provided to the front-end department at all locations.
• Coordinate with front end regarding scheduling errors.
• Assist front end staff and call center staff in understanding carrier websites and verification of eligibility.
• Enter insurance referrals as needed.
• Broad understanding of insurance company requirements related to services that require referral, pre-certification or prior authorization required.
• Participates in development of organization procedures and update of forms and manuals.
• Answers questions from patients, clerical staff and insurance companies.
• Works in conjunction with the reception to ensure clean billing.
• Performs miscellaneous job-related duties as assigned.
• Participates in educational activities and attends monthly staff meetings.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Assists in development and communication of SOP for key areas to improve accuracy and understanding of processes.

Qualifications/Skills:

• Minimum of 1 year of relevant experience and/or training, or equivalent combination of education and experience.
• Strong knowledge of administrative and clerical procedures.
• Proficient in computers and relevant software applications and practicing management technology.
• Ability to collaborate across departments and build effective relationships with internal and external customers to achieve goals.
• Knowledge of customer service principles and practices.
• Ability to achieve team goals while demonstrating organizational values and utilizing resources responsibly.
• Ability to be proactive and take initiative.
• Exhibit high level of quality through attention to detail and monitoring of work.
• Possession of strong organizational skills.
• Excellent verbal and written communication, as well as exceptional interpersonal communication skills.

What We Offer:

• Immediately accrue PTO as you work! (Full Time)
• 6 Observed Holidays
• Medical, Dental, Vision, Life and other voluntary insurances for full-time employees
• 401(k) Retirement plan
• Employee Assistance Program

Who is Rezolut?

Rezolut is a national emerging platform of diagnostic medical imaging services. With focus on four key platforms, our vision is to provide topnotch patient care partnered with innovative technology — to achieve better health outcomes. We provide high-quality, cost-effective, fixed-site outpatient diagnostic imaging as well as mobile imaging and health services. In each of our regions, we are the best in radiology, offering all radiology services!

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