PreCert Specialist - Full-Time - Germantown, TN
Core
Front-line specialist ensuring patients have required precertification for procedures, drugs, and radiology services at a cancer care center.
Role type
Healthcare insurance precertification specialist
Builds
Insurance authorizations and accurate patient documentation for medical procedures
Domain
Healthcare / Cancer Care / Insurance Administration
Deliverable
client delivery
Required skills
Medical terminology, managed care knowledge, insurance claims processing, payer policy research, medical necessity review, ICD-10/CPT/HCPCS coding familiarity, Microsoft Office proficiency
Preferred skills
Chemotherapy and radiology precertification experience
Responsibilities
Verify demographic and insurance information; Update demographic and insurance records; Obtain and review physician orders for medical necessity; Research insurance coverage criteria; Generate and review appointment reports; Communicate with medical teams to ensure criteria are met; Obtain and review authorizations; Review self-pay patients and coordinate assistance programs; Support appeals and peer-to-peer requests; Assist with resolving cases returned from office site team
Seniority
Mid-level, hands-on specialist