Precertification Coordinator Resume Samples

A Precertification Coordinator is responsible for obtaining prior authorization for procedural orders by completing the authorization process with all commercial payers. Roles and responsibilities are listed on the Precertification Coordinator Resume as – reviewing chart documentation to ensure patient meets medical policy guidelines, prioritizing incoming authorization requests according to urgency, obtaining authorization via payer website or by phone and following up regularly on pending cases, maintaining individual payer files to include up to date requirements needed to successfully obtain authorizations, initiating appeals for denied authorizations, responding to clinic questions, and confirming the accuracy of CPT and ICD-10.

While the job duties vary as per the industry, the needed skills are universally common and include the following – knowledge of procedure authorization and its direct impact on the practice’s revenue cycle, a good understanding of payer medical policy guidelines, a basic understanding of human anatomy, proficiency in using CPT and ICD-10; and the ability to multitask. A high school diploma or GED along with prior authorization experience is preferred.

Precertification Coordinator Resume example

Precertification Coordinator Resume

Objective : A dedicated Precertification Coordinator skilled with technical, clerical and patient support. I have a strong ability to communicate clearly and effectively to patients and staff. Trained to work in hospitals, schools, corporate settings, legal and medical offices, or government agencies. A dedicated Administrative Assistant skilled with technical, clerical and patient support.

Skills : Microsoft Office., Greenway Operating Systems., Multi-Line Phone System, Scanning, Insurance Verification, Scheduling.

Description :

    1. Improved productivity, and resolving complex departmental issues.
    2. Collaborated with Human Resource department to ensure efficient office environment for staff and supervise office operations for staff of 20 employees.
    3. Coordinated meetings with other department managers and served as main liaison between denials management dept.
    4. Managed daily office operations, maintenance of equipment, and maintaining accurate records for all business supplies.
    5. Updated patient accounts and information daily, verified and created claim numbers by communicating with various insurance companies, verified payments done by insurance companies were accurate and according to contract guidelines.
    6. Created spreadsheets to improve inventory management and reporting accuracy.
    7. Managed incoming and outgoing calls for busy pre-certification department, assisted in all areas of administrative work including data entry, receptionist duties, file organization, research and development managed hundreds of accounts receivable accounts working directly with the Financial Management Office.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
GED


Precertification Coordinator Resume

Summary : A motivated Precertification Coordinator professional seeking a position in a challenging environment. Over 10 years experience successfully providing administrative, secretarial and financial support in the healthcare field. Proficient in a range of computer applications. Well-developed communication and customer service skills. Proven ability to efficiently plan and manage multiple assignments to meet tight deadlines. A proactive problem-solver who gets the job done.

Skills : Maintains Strict Confidentiality L Knowledge Of HMOs,.

Description :

    1. Administered financial counseling to patients and their families.
    2. Coordinated financial care with Case Managers of appropriate insurance plans to obtain approvalsand benefits for pre transplant evaluation and listing phase.
    3. Secured authorizations for all post transplant surgeries, procedures, office visits and labs.
    4. Obtained referrals from PCP if required from benefit plan.
    5. Verified eligibility and benefits for all patients.
    6. Maintained the Status spreadsheet of all pre and post transplant patients.
    7. Organized a system that maximized authorization rate by using a QA process that allowed me to capture every office visit, procedure, labs etc so verification and benefits can be performed on all patients.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor's


Precertification Coordinator Resume

Headline : Seeking a Precertification Coordinator profession with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.

Skills : Networking, Microsoft Powerpoint, Leadership Development, Team Player, Customer Service, General Office.

Description :

    1. Obtained referrals and/or precertification of ordered services such as office visits, procedures, therapies, referrals, radiology tests and medications for MCR/MCD, MCR/MCD products, commercial carriers and occasionally BWC.
    2. Kept current on various clinical guidelines, CPT & ICD-9 coding practices.
    3. Liaisoned between staff, insurance carriers and patients regarding insurance policy practices, precertification processing and/or an appeal process.
    4. Created documents for efficiency of precertification(s)/appeals, spreadsheets/graphs for statistical purposes, forms and form letters.
    5. Scanned and assigned documents into the McKesson EMR system.
    6. Verified insurance eligibility/benefits.
    7. Able to implement my own templates and computer set up for the highest efficiency.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Junior
Education
Education
Diploma

Precertification Coordinator Resume

Summary : Precertification Coordinator with extensive experience supporting physicians and medical professionals. Strengths include: Patient pre-certification and counseling Attention to detail and reliability Scheduling Time management Analyze medical records Customer satisfaction.

Skills : Bookkeeping, Analysis & preparation.

Description :

    1. Responsible for acting as a liaison between the physician's office and the insurance company.
    2. Obtained precertification of procedures for physician's offices from various insurance carriers.
    3. Obtained applicable benefits for hospitals.
    4. Used payer-specific websites to obtain benefits and complete certifications.
    5. Met daily minimum productivity standard and score 95% on all audits.
    6. Conveyed gained insights and knowledge to other team members.
    7. Documented all emergency admitted patients for 45 physicians within several departments.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
MS

Precertification Coordinator Resume

Objective : Precertification Coordinator with 4+ years of experience in Activating member in a patient centered-team approach in the care of the patient and families, Working collaboratively with all team members in achieving shared goals with a consistent focus on quality care, Participating in quality improvement activities including data analysis, implementing recommendations, evaluating changes and outcomes.

Skills : Medical Terminology, Dental Assistant.

Description :

    1. Managed detailed patient flow from admission to discharge.
    2. Used programs such as Eclipsys, Epic, and IDX for patient demographic entries, admissions, and discharges.
    3. Established and maintained effective working relationships with Drug Reps.
    4. Standardized department filing system so secretarial staff could easily locate information in any filing center.
    5. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service, and managed care plans.
    6. Calculated Coordination of Benefits (COB).
    7. Hired as an Admit Clerk and 6 months later promoted to Precertification Coordinator.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Diploma

Precertification Coordinator Resume

Objective : Inpatient and outpatient records coding specialist with ICD-9, ICD-10, and Precertification expertise. Familiar with commercial and private insurance carriers as well as registering patients, scheduling appointments and recording and filing patient medical records. Seeks a position of increased responsibility.

Skills : MS Office, Adobe Office, and research databases; Languages: Intermediate knowledge of French and Spanish.

Description :

    1. Recorded and filed patient data and medical records.
    2. Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
    3. Consistently ensured proper coding, sequencing of diagnoses and procedures.
    4. Quickly responded to staff and client inquiries regarding CPT codes.
    5. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
    6. Confirmed patient information, collected copays, and verified insurance.
    7. Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification, and provider signature.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
High School Diploma

Precertification Coordinator Resume

Objective : Seeking a position as a Precertification Coordinator at a facility where my experiences will provide phenomenal health care services to all patients. I plan to bring my newly trained skills and intermediate knowledge to your facility in hopes of growth.

Skills : Training Skills, Financial Skills.

Description :

    1. Provided necessary information for authorization and stay/visit re-authorization.
    2. Reviewed information for admission and visit management including type and duration of service, authorization and treatment codes, re-authorization and visit requirements necessary for ongoing treatment and payment.
    3. Actively membered in a patient-centered-team approach in the care of the patient and families.
    4. Worked collaboratively with all team members in achieving shared goals with a consistent focus on quality care.
    5. Participated in quality improvement activities including data analysis, implementing recommendations, evaluating changes and outcomes.
    6. Experienced in ambulatory/physician office setting preferred. 
    7. Knowledged of insurance and managed care companies preferred.
        Years of Experience
        Experience
        2-5 Years
        Experience Level
        Level
        Executive
        Education
        Education
        GED

        Precertification Coordinator Resume

        Headline : To obtain a Precertification Coordinator, responsible for Entering patient insurance authorizations and any pertinent information from the insurance company into the patient account history, Documenting insurance coverage of services to be provided, Notifying case management about interactions with insurance companies regarding services, and also Managing denials or potential denials as described by the insurer.

        Skills : Coordinating Skills, Billing Skills.

        Description :

          1. Primary contacted outpatient families regarding insurance referring them to the patient accounting department as needed.
          2. Responsible for obtaining complete and accurate insurance information, benefits verification, accurately interpreting benefit plans, and investigating pertinent details.
          3. Notified supervisor of known or potential insurance coverage issues.
          4. Reviewed information for admission and continued visit management including type and duration of service, authorization and treatment codes, re-authorization, and continued visit requirements necessary for ongoing treatment and payment.
          5. Responsible for explaining benefits, the billing process, and financial responsibility to parent/guardian.
          6. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
          7. Worked with a lot of elderly patients and if I could just make one person's day I felt like I accomplished a whole lot.
        Years of Experience
        Experience
        5-7 Years
        Experience Level
        Level
        Executive
        Education
        Education
        GED

        Precertification Coordinator Resume

        Objective : A position in Precertification Coordinator where I am able to utilize my skills in performing general nursing functions, Quality Assurance, Utilization Review, and specializing in Med Surg, Pediatrics, Psychiatric Nursing, Wound care, and OB-GYN as well as strong public relations and customer service skills.

        Skills : Microsoft Office, Planning Skills, Organisational Skills.

        Description :

          1. Responsible for overseeing case management of insurance, including verifying insurance Pre-Authorizations, Certifications, and Re-Certifications.
          2. Managed multiple insurance contracts/exclusions and negotiate carve-outs.
          3. Reviewed and communicated the plan of care for the delivery of services covered during stays in skilled nursing facilities.
          4. Ensured appropriate insurance level of payment including proper ICD9 coding.
          5. Reviewed clinical information provided with the request and determines if it meets UM criteria.
          6. Prepared a detailed, organized analysis of information for the daily management reports.
          7. Initiated effective and timely insurance case management interface.
        Years of Experience
        Experience
        2-5 Years
        Experience Level
        Level
        Executive
        Education
        Education
        GED

        Precertification Coordinator Resume

        Objective : To obtain a fulltime position with a company or organization or business where I may best use my skills, education, and abilities to their fullest extent. Searching for a company with benefits, upward mobility and stability, and competitive salary. Note- I am currently attending Ashford University online to complete my bachelor's degree in Health Informatics.

        Skills : Implementational Skills, Coordinating Skills.

        Description :

          1. Involved communication with Commercial Insurance Companies and Workers Compensation Nurse Case Managers to verify patient coverage and benefits.
          2. Demonstrated and completed training processes for Knowledge of ICD9 diagnosis coding Knowledge of CPT4 procedural coding Knowledge of Medical terminology Ability to summarize clinical information in writing or orally for Medical Management or Adjusters Knowledge of Mysis and Tiger computer software from registration through finalization of printing charge tickets Required extensive knowledge of medical billing and follow-up, practice management, accounts receivables, in addition to other accounting procedures such as accounts payable and account reporting used for orthopedic practices.
          3. Reviewed of accounting skills see Hertford Gates Health Department on Other related employment.
          4. Responsible for checking insurance eligibility for outpatients at least every 90 days and annually in January and July via electronic medical records and insurance websites.
          5. Appealed for additional services (extended stays, visits, authorization extension, and letter of medical necessity) and refers to additional resources when necessary.
          6. Progressed through career ladder from Rep to Coordinator in three years Responsible for reinventing the training process for new employees, and creating paperless reference and training material.
          7. Worked with insurance companies and MD offices to obtain authorizations for patient's needed medical tests and procedures.
            Years of Experience
            Experience
            2-5 Years
            Experience Level
            Level
            Junior
            Education
            Education
            MS