Pre-Certification Specialist at Allied Digestive Health in Albany, New York

Job Description:

Albany Gastroenterology Consultants has partnered with Allied Digestive Health, one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report.

We are excited to announce that we are looking for a Full-Time Pre-Certification Specialist at Albany Gastroenterology Consultants in Albany, New York.

The Pre-Certification Specialist is responsible for obtaining authorizations for ordered procedures, timely and accurately, to ensure reimbursement for outpatient services. The specialist is responsible for providing complete documentation of clinical information to payers in support of healthcare services to be authorized.

The Pre-Certification Specialist responsibilities are:

• Knowledge of participating insurances and authorization requirements.


• Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans, and investigating pertinent details.


• Ability to verify patient eligibility and pre-certification requirements through online resources or via telephone.


• Effectively communicate with families; when appropriate, regarding benefit details and limitations.


• Documents detailed communication with payors and clinical support in the authorization fields.


• Contacts family with any insurance issues that may prevent obtaining a referral/pre-certification.


• Timely management of incoming responses.


• Provide team coverage when needed.


• Maintain professional and courteous demeanor at all times with patients, physicians, and co-workers


• Adhere to and support all policies and procedures of Albany Gastroenterology Consultants


• Other responsibilities as assigned

The Pre-certification Specialist must have the following qualifications and experience:

• High School graduate or equivalent


• No experience is required, 1 to 3 years of experience is preferred as follows:
  
  
  • Experience in processing prior-authorizations and referrals is preferred.
  
  
  • Understands the concept of PCP and referrals protocols as defined by Insurance Carriers
  
  
  
  

We offer a competitive base salary, generous benefits, including: Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.

Job Type: Full-Time Apply Now