Pre Cert Rep - DeKalb Patient Accounting - FT - 1st Shift at Huntsville Hospital Health System

Fort Payne, Alabama, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Jul, 26

Salary

0.0

Posted On

09 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior authorization, Insurance verification, Medical billing, CPT coding, ICD-10 coding, HCPCS coding, Clinical documentation review, Attention to detail, Communication, Problem-solving, Multitasking, Organizational skills, Data entry, Payer guideline compliance

Industry

Hospitals and Health Care

Description

Overview The Outpatient Pre-Certification Representative is responsible for obtaining prior authorizations for outpatient procedures, diagnostic services, and treatments. This role ensures all scheduled outpatient services meet insurance requirements prior to the date of service, helping reduce denials and delays while supporting efficient patient care. Responsibilities -Obtain pre-authorizations for outpatient procedures such as imaging, surgeries, therapies, and specialty services-Verify patient insurance eligibility, benefits, and coverage for outpatient services-Review physician orders and clinical documentation to determine authorization requirements-Submit authorization requests to insurance providers with appropriate clinical information-Track and follow up on pending authorizations to ensure timely approval before scheduled services-Communicate authorization status to scheduling teams, clinical staff, and patients-Identify services that do not require authorization and document appropriately-Resolve authorization issues, including denials or incomplete requests-Maintain accurate documentation of all interactions and approvals in electronic systems-Ensure compliance with payer guidelines and hospital policies Qualifications Education: High school diploma or GED required; healthcare-related education preferred. Experience: -1–3 years of experience in insurance verification, pre-certification, or medical billing (outpatient preferred).-Knowledge of outpatient procedures and insurance authorization processes.-Familiarity with CPT, ICD-10, and HCPCS coding (preferred). Skills & Competencies:-Strong attention to detail and accuracy-Excellent communication and coordination skills-Ability to manage high-volume workload and meet deadlines-Problem-solving skills for handling authorization issues and denials-Strong organizational and multitasking abilities About Us DeKalb Regional Medical Center celebrated its 35th anniversary in October 2021. Throughout its history, the team of healthcare providers here have been proud to serve the people of Fort Payne, Alabama. Today, DeKalb Regional is 134-beds and offers comprehensive services including cardiac catheterization, geriatric psychiatric services, women’s and children’s services, bariatric services, orthopedics services, and many more. DeKalb Regional and its physicians serve patients from throughout Northeast Alabama and Western Georgia. DeKalb Regional is committed to providing quality care close to home. The hospital is accredited by The Joint Commission and the American College of Cardiology as a Primary Stroke Center and Chest Pain Center. It was also awarded the 2023 Get with the Guidelines Rural Stroke Bronze Quality Award from the American Heart Association. In fall of 2023, DeKalb Regional was one of seven hospitals in Alabama to receive an “A” grade from The Leapfrog Group. DeKalb Regional Medical Center has 500 employees and more than 100 members of the medical staff.

Responsibilities

The Pre-Certification Representative is responsible for obtaining prior authorizations for outpatient procedures and verifying insurance eligibility. They must also resolve authorization issues, track pending requests, and maintain accurate documentation in electronic systems.