Pre-Certification Specialist - Gainesville
1 day ago

Job description
JOB TITLE:
Pre-Certification Specialist
Hour of Work:
Monday – Friday
Shift:
Day
Employment Type:
Non-Exempt
Direct Report:
Hospital Scheduling Manager
Director:
Director of Clinical Support
Key Responsibilities
Pre-certify insurance and obtain authorizations for all office appointments (Office Visits, Testing, Nuclear, and PET)
Submit denied authorization requests for Clinical Review, Peer-to-Peer Review, or file appeals with the insurance company.
Verify patient insurance information prior to appointment date.
Scan all documentation regarding cardiac procedures, testing, and referrals.
All other duties as assigned.
The job holder must demonstrate current competencies applicable to the job position.
Qualifications/Requirements
High School graduate or GED
Minimum 1 year insurance experience in a health care organization or specialty practice, preferably Cardiology-based.
Proficiency in standard EHR and Practice Management software is required.
Proficiency in medical terminology with emphasis on Cardiology.
Working knowledge of insurance guidelines and terminology as well as CPT and ICD-10 coding.
Basic knowledge of electronic medical records retrieval system, computers, and the Internet.
Perform multiple tasks and meet deadlines.
Communicate effectively, efficiently, and professionally.
Knowledge of Intergy and Medical Manager systems highly preferred.
Similar jobs
The Pre-Certification Specialist will precertify insurance and obtain authorizations for all office appointments. · ResponsibilitiesPrecertify insurance and obtain authorizations for all office appointments (Office Visits, Testing, Nuclear, and PET) · Submit denied authorization ...
1 week ago
This Pre-Certification Specialist role involves pre-certifying insurance and obtaining authorizations for office appointments. · ...
1 week ago
The Department Applications Specialist is an experienced professional with strong computer proficiency and exceptional customer service skills. This role is responsible for accurately scheduling patients, · updating and maintaining information within the PHS systems, · ...
4 weeks ago
The Advanced Registerd Nurse Practitioner is responsible for performing comprehensive medical evaulations including ordering and the interpretation of laboratory studies and diagnostic tests for pre-surgical patients. · ...
2 weeks ago
Patient Access Representative | Full Time | Night Shift - 10:00 PM TO 8:30 AM
Only for registered members
The Registration Assistant performs essential duties including appointment scheduling and patient registration insurance verification and pre-certification telephone coverage and general patient inquiries data entry and filing of protected health information PHI coordinating pati ...
2 weeks ago
Manages high-dollar outpatient service accounts requiring complex authorization and coordination across multiple clinical areas. · ...
3 weeks ago
Surgical Technologist Spec 3-12 | OR North | Variable | Full Time
Only for registered members
Assist as a member of the surgical team who works with the surgeon registered nurse and anesthesiologist delivering direct patient care before during and after surgery. · ...
6 days ago
The patient access specialist manages high-dollar outpatient service accounts requiring complex authorization and coordination across multiple clinical areas. · Manage high-dollar outpatient service accounts to ensure accurate and timely financial reimbursement. · ...
2 weeks ago
Manages high-dollar outpatient service accounts requiring complex authorization and coordination across multiple clinical areas. · ...
1 week ago
This position performs clinical laboratory testing and receives all requests and specimens for testing into the laboratory. · Receives all requests and specimens for testing into the laboratory · Assigns priority to test requests and executes them expeditiously for use in critica ...
1 month ago
+We are seeking an experienced OPEX Specialist in Gainesville. This position will lead transformative initiatives enhancing efficiency across the organization. · ++Bachelor's degree in engineering or equivalent combination of education and experience · Minimum 5 years of experie ...
2 weeks ago
We are seeking a full-time OR Supervisor – Aesthetic Plastic Surgery to lead clinical operations in a luxury patient-centered surgical practice. · An active Florida RN licenseBLS/ACLS certifications3+ years of OR circulating experience (plastic surgery preferred)Prior supervisory ...
1 month ago
We are seeking a full-time OR Supervisor – Aesthetic Plastic Surgery to oversee daily clinical operations in a luxurious, patient-centered environment. · Lead and support nursing staff, surgical techs, and assistants, · Maintain regulatory compliance (QUAD A, OSHA, HIPAA) · ...
1 month ago
We are seeking an experienced and highly motivated Operational Excellence (OPEX) Specialist to join our team in Gainesville, Florida. This position will lead transformative initiatives that enhance efficiency and quality across the organization. · ...
1 month ago
Accountable for receiving and processing both emergency and non-emergency calls by; providing appropriate pre-arrival instructions; entering data into a computer-aided dispatch (CAD) system; · Within one (1) year of hire, the Telecommunicator must train and demonstrate proficienc ...
1 month ago
ECMO Specialist | Full TIme | 3/12s | ECMO | Gainesville
Only for registered members
The ECMO Specialist is responsible for daily operation of the ECMO program under direction of the ECMO Coordinator. · Maintain effective assessment of ECMO circuit function and integrity. · Ensure administration of blood products accurate and safe for patients ranging neonatal to ...
2 weeks ago
UF/IFAS Extension Housing and Financial Education Program Specialist
Only for registered members
The program specialist will enhance the UF/IFAS First-Time Homebuyer curriculum in both English and Spanish under the leadership of the Associate Program Leader (APL) for Housing Education. · Collaborate with county agents to create new financial education modules. · Teach progra ...
1 month ago
Make an impact by joining ServiceSource, a champion for people with disabilities. · ...
1 month ago
Make an impact by joining ServiceSource, a champion for people with disabilities. · The Rehabilitation Specialist III is responsible for providing clerical and fiscal support for the counseling and administrative staff. · ...
1 month ago
Accountable for receiving and processing both emergency and non-emergency calls by; providing appropriate pre-arrival instructions; entering data into a computer-aided dispatch (CAD) system; · evaluating situations and making decisions as to the assistance and needs of callers ba ...
2 weeks ago