Precertification Representative

Job Summary

A company is looking for a Precertification and Authorization Representative to support insurance-specific plan requirements.

Key Responsibilities

• Resolve referral, precertification, and prior authorization for various payors in hospital and clinic settings
• Process pre-appointment insurance reviews and manage denials recovery functions
• Adhere to quality assurance guidelines and productivity standards to meet performance expectations

Required Qualifications

• High School Diploma or GED with 2+ years of relevant experience, or a Bachelor's degree
• Basic computer/keyboarding skills and intermediate math competency
• General knowledge of healthcare terminology and CPT-ICD10 codes
• Preferred knowledge of insurance verification and claim adjudication
• Healthcare Financial Management Association (HFMA) Certification is preferred