Pre-Certification Specialist
Atlantic Medical Imaging
Summary
The Pre-Certification / Pre-Service Specialist is responsible for ensuring that all outpatient insurance requirements are completed in advance of patient's scheduled appointment date. The team works directly with AMI's referring provider offices.
Job description
Responsibilities
- Evaluates patient's scheduled procedures to determine if prior authorization is required.
- Reviews and validates patient insurance information to confirm coverage for scheduled procedures, leveraging a strong understanding of insurance plans and their specific provisions.
- Monitors authorization request, follows up with payers, and records all communications regarding insurance claims.
- Reviews insurance denials, resubmits claims, and submits appeals as necessary to ensure patients obtain required care.
- Ensures patient insurance eligibility is verified and authorizations are obtained through insurance portals (e.g., Evicore, etc.) on behalf of physician practices registered with the AMI Pre-Authorization Service, when applicable, prior to the patient's scheduled procedure or testing date.
- Communicates updates in pre-authorization procedures to management to keep the pre-certification manual accurate and current. Documents denial reasons and contributing factors to ensure team alignment with industry standards.
- Maintains an up-to-date list of facility insurance pre-certification agreements.
- Other duties as assigned.
This Full time, 40 hour per week position is remote and includes a work schedule of Monday-Friday, 8:30am-5pm. Candidates must be able to travel to AMI offices for initial training, occasional meetings, and ongoing training.
Requirements
- High school diploma or equivalent
- At least 2 years' experience with insurance coverage verification in a medical practice or healthcare setting
- Intermediate computer skills with working knowledge of Microsoft Office Suite
- Experience with online medical insurance portals
- Demonstrated knowledge of insurance plans and the authorization process
- Ability to remain highly organized with accounts
- Ability to work independently and receive & implement direction with minimal supervision
- Detail oriented while managing a high volume of requests
- Exceptional interpersonal skills
- Verbal & written communication skills
- Customer service skills
Benefits
- Medical, Prescription, Dental & Vision
- Flexible Spending Accounts
- Paid Time Off (PTO)
- Paid Holidays
- 401(k)
- Profit Sharing
Company overview
Atlantic Medical Imaging (AMI) is a leading diagnostic imaging practice based in New Jersey, founded in 1964 as a one-man radiology practice at Atlantic City Medical Center. The organization has grown into one of the top 100 radiology practices in the United States, operating 29 office locations across seven New Jersey counties. AMI specializes in comprehensive medical imaging services including MRI, CT, PET/CT, 3D mammography, ultrasound, DEXA scans, nuclear medicine, and x-rays. The practice employs over 68 board-certified radiologists and vascular surgeons with extensive training in various medical subspecialties, supported by a staff of more than 900 professionals. AMI is recognized for its commitment to clinical excellence, innovative service delivery, and compassionate patient care, utilizing state-of-the-art technology to provide accurate diagnostic results with rapid turnaround times. The organization also operates a specialized Vascular Institute offering minimally invasive treatment options for peripheral arterial disease and other vascular conditions. With a strong focus on community service and patient-centered care, Atlantic Medical Imaging has established itself as the premier medical imaging provider in southern New Jersey.