Precertification Specialist Resume Samples

A Precertification Specialist is responsible for gathering authorizations for every procedure in the organization. Some of the roles and responsibilities for a Precertification Specialist Resume are reviewing chart documentation, obtaining authorization, maintaining payer files individually, initiating appeals, responding to clinical questions, contacting patients to discuss status, and perform any other duties assigned.

Some of the vital skills and abilities needed for this role are a basic understanding of human anatomy, proficient use of basic CPT codes, excellent computer skills, ability to work under pressure and meet deadlines, great customer service skills, ability to multitask, understanding of the patients and their needs, a flair for sticking to rules and guidelines, and strong grasping skills. On the qualifications front, a high school diploma with a minimum of two years of experience in a relevant medical-related field is considered important.

Precertification Specialist Resume example

Precertification Specialist Resume

Objective : Responsible for the verification of insurance benefits and obtaining prior authorizations for all procedural orders by successfully performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.

Skills : Medical Terminology, Office Equipment, Office Administration, Injections, EKG, CPT, ICD-9, Patient Care.

Description :

    1. Ensured the effective and efficient use of services, monitors appropriateness and medical necessity, and provides necessary information for authorization and continued stay/visit re-authorization.
    2. Provided support to the patient accounting department to clarify claim submission and claim denial appeal efforts.
    3. Assisted with patient intake.
    4. Interacted as an active liaison between hospitals, medical facilities, surgical schedulers, medical doctors, Insurance Companies, and via another precertification specialist.
    5. Reviewed information for admission and continued visit management including type and duration of service, authorization and CPT/HICPIC/ICD-10 codes for treatment, re-authorization and continued visit requirements necessary for ongoing treatment and payment.
    6. Responsible for explaining benefits, the billing process and financial responsibility to parent/guardian.
    7. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
High School Diploma


Sr. Precertification Specialist Resume

Summary : Front Desk Supervisor/ Billing, Collections, Precertification Specialist Dedicated insurance professional with more than 10 years of experience in the medical field, Excel in analyzing claims, Authorizations and Pre-certifications. Effectively manage multiple high priority projects and take pride in providing exemplary customer service.

Skills : Microsoft, Successful Worker.

Description :

    1. Obtained patients clinical history and insurance documents from referred physician's office.
    2. Scaned and documented patient's demographics to initiate precertification process.
    3. Coordinated patients scheduling changes according to certification status.
    4. Obtained authorization for various procedures for cardiac services.
    5. Included office visits and nuclear testing.
    6. Obtained referrals when required and delegating clinicals to third party companies for testing.
    7. Worked one on one with doctor and nurse case managers to justify services rendered.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Senior
Education
Education
BS


Jr. Precertification Specialist Resume

Headline : To secure a position within a medical office that will benefit from nineteen years experience in patient care services, insurance, front desk operations, and strong organizational skills.

Skills : MS Word, MS Excel, MS Power Point, MS Outlook, MS Access, Adobe Acrobat, MAC, Internet, OPERA, PMS.

Description :

    1. Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
    2. Notified supervisor of known or potential insurance coverage issues.
    3. 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.
    4. Responsible for explaining benefits, the billing process and financial responsibility to parent/guardian.
    5. Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
    6. Responsible for tracking, obtaining and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
    7. Appealed for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Junior
Education
Education
High School Diploma

Precertification Specialist III Resume

Headline : To become a valuable member of your team by utilizing and expanding skills and training as a medical administrative assistant.

Skills : Word, Excel, Excel, Powerpoint.

Description :

    1. Insuranced eligibility check and verification of benefits.
    2. Scheduled surgeries with patient at local hospitals, or surgical center.
    3. Obtained authorizations for procedures, including documentation, and setting up of peer to peers.
    4. Verified all physical therapy benefits, and order all DME equipment, as well as all discharge plans to rehabilitation centers.
    5. Completed booking sheets, and all pertinent information from labs, primary care doctors, and radiology facilities.
    6. Verified consents forms and all information is gathered for surgery.
    7. Responsible for prescription refills, answers to patient and insurance question, and mailing out of all patient information.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Case Management

Precertification Specialist II Resume

Objective : To obtain a position at a reputable company by utilizing fifteen years of administrative and medical experience.

Skills : Office Equipment, Insurance Verification, Precertification, Front Desk.

Description :

    1. Called patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.
    2. Attempted to obtain, and documented in the computer system, referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
    3. Obtained and documented in the computer system the pre-certification/pre-authorization number from insurance companies prior to each surgical procedure and diagnostic test.
    4. Assisted patients with scheduling new patient office visits with CVCP provider offices.
    5. Created and distributed the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.
    6. Completed all fields within the computer system necessary to process claims and re-route claim to the billing department per assigned deadline.
    7. Distributed The Admit List daily by 1 p.m., identify possible CVCP patients and distribute list to pre-certification staff for processing.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Certificate In Business

Precertification Specialist I Resume

Summary : An enthusiastic and hard working college student seeking to obtain experience and knowledge through a full time position in this facility.

Skills : Customer Service, Insurance Verification, Data Entry, Computer, Microsoft Office, Team Player.

Description :

    1. Obtained authorizations for many referring doctors, between 800-900 a month.
    2. Verified insurances, checking eligibilty.
    3. Greeted patients, checking in patients, and making sure all patients information is accurate.
    4. Answered questions of co-workers and solving patients questions.
    5. Assisted the tech's when needed.
    6. Assisted over 100 doctors a month with precertifications and making sure their patients are scheduled accurately.
    7. Worked with prescribing physicians to determine patients' eligibility for insurance coverage of prescription medications.
    8. Evaluated medical diagnoses, state laws and previous treatments to determine exceptions to formulary plan coverage.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Nursing

Assistant Precertification Specialist Resume

Summary : Looking for a positive team-centered environment with core values. Very much a multi tasker, detail-oriented, and am used to the fast paced world of medical clinics. Experience varies in many EMRs such: Meditech, Medisoft, Mysis, Eclinical, Advocate, Infinit, Centricity, IDX, QSI, RIS/PACS, NextGen, Greenway.

Skills : Microsoft Word, Epic, RIGHTFAX.

Description :

    1. Answered phones with multiple lines.
    2. Pre-certified insurances for Physical Therapy.
    3. Scheduled patients using Sage Intergy.
    4. Assisted the Doctor with EMG/NCS diagnostic testing.
    5. Answered inquiries from persons entering establishment.
    6. Collected and distributed mail and messages.
    7. Responsible for pulling medical records and phoning patients for appointments.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Diploma In General

Associate Precertification Specialist Resume

Summary : Over 20 + years of experience with a solid background in the area of healthcare services that includes proven leadership and management skills with a strong knowledge of consulting, training, development and project management. Program Development Client Relations Management Payroll Management Supervision and Training Leadership Diversity.

Skills : Microsoft Office, Medical Records, Medical Billing.

Description :

    1. Recorded insurance information to maintain data through the Referral/Insurance Verification process and communicates insurance information to pertinent staff including therapists, coding and finance.
    2. Independently maintained and worked from the electronic medical record and additional databases.
    3. Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.
    4. Notified supervisor of known or potential insurance coverage issues.
    5. Responsible for accurate determination of payor sources and communication to those payor sources relating to each patient visit.
    6. Primary contacted for outpatient families regarding insurance referring them to the patient accounting department as needed Responsible for explaining benefits, the billing process and financial responsibility to parent/guardian.
    7. Responsible for tracking, obtaining and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Project Management

Assistant Precertification Specialist I Resume

Summary : Objective is to find a permanent position in a medical office setting where can apply knowledge and skills, Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details.

Skills : Typing, Organization, Customer Service, Executive Support, Communication, Team Player, Accounting, Bookkeeping.

Description :

    1. Assisted with greeting incoming patients, completing/distributing paperwork, entering pertinent patient information into the electronic medical record, and verifying insurance eligibility.
    2. Assisted in the development, organization and maintenance of role specific documents, policies, and tools.
    3. Worked independently and manage work time Document accurately and record patient/insurance information Speed and accuracy in data entry Medical .
    4. Helped develop the policies for the Precertification Department which was implemented throught all Mercy facilities.
    5. Corrected any account in which errors have occurred per assigned deadline.
    6. Maintained communication among the physician, insurance company, and CVCP at all times regarding authorization and CVCP Auth status on patients.
    7. Enrolled customers in specialized care programs Managed financial spending accounts Processed determination letters based on insures clinical .
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Associates In Medical Billing

Precertification Specialist Resume

Summary : Looking forward to succeeding in a cultivating environment, while experiencing opportunities to advance throughout the company.

Skills : Microsoft Office, Gemms, Pre-certs, Referrals, Navinet, Medhost, As400, Center, Passport Ecare.

Description :

    1. Responsible for pulling doctors schedules daily and obtaining clinical information needed to obtain prior authorization from insurance companies for all surgeries and diagnostic testing.
    2. Generated referrals to insurance companies.
    3. Communicated authorizations to hospital and doctors.
    4. Registered insurance info in computer.
    5. Precertified all surgeries and diagnostic testing in a fast paced multi-specialty practice.
    6. Used Extremely detailed oriented, multi-tasking efficient, excellent time management skills.
    7. Experienced with fast pace office environment, customer service experience, administrative and clerical expertise, strong organizational skills, efficient in meeting deadlines, task oriented with minimal supervision required.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BS In Dietetics