<p>Connecticut GI, a division of GI Alliance, is looking for a full-time experienced Pre-Certification Specialist to join our Rocky Hill Care Center! We are the largest gastroenterology practice in the state of Connecticut with 31 Care Centers and still growing. Our employees are the foundation of our practice and we pride ourselves on the fact that we have been named a TOP WORKPLACE 8 times! Our team of clinical and administrative support staff work collaboratively with our physicians and advanced practitioners to provide our patients with the most comprehensive and compassionate care. Here at CTGI our promise is to treat every patient as if they were a member of our own families, and we are looking for team members who also embody this vision!</p> <p>A Short List Of Reasons Why You Should Work For CTGI</p> <ul> <li>Selected as a Top Workplace 8 Times </li><li>Competitive Pay </li><li>Very Fast-Growing Practice </li></ul> <p>Job Summary:</p> <p>Reporting to the Site Supervisor, the Procedure Prior Authorization Billing Specialist will provide support to the Practice by ensuring that the insurance pre authorization is completed prior to the patient's procedure.</p> <p>Duties/Responsibilities:</p> <ul> <li>Responsible for ensuring that CTGI has the appropriate insurance pre-certification/preauthorization (when required by insurance) prior to the scheduled procedure. </li><li>Obtain Retro Auths as needed </li><li>Maintain current knowledge of covered and non-covered CPT codes, and ICD 10 codes by using monthly payer bulletins and updates provided by Team Lead, Supervisor or Manager </li><li>Review and provide documentation for Medical Necessity and/or Site of Service Insurance protocol requirements </li><li>Work within the established timeframe which is currently 14 days out from date of service </li><li>Maintain incoming faxes which includes reviewing, distributing and uploading as needed </li><li>Utilize Payer Websites when available </li><li>Actively communicate with staff and providers from all appropriate entities throughout the work-day regarding any changes to scheduled procedures. </li><li>Maintain proper notation in patient chart following all established protocol </li><li>Identify and communicate ongoing issues and payer trends to Team Lead, Supervisor and Manager before issues have escalated </li><li>Follow established policies, control processes, procedure and guidelines </li><li>Check email frequently throughout the day to ensure all communications are received </li><li>Other duties as assigned </li></ul> <p>Required Skills/Abilities:</p> <ul> <li>Strong problem-solving skills </li><li>Possess strong computer skills, including proficiency in Excel </li><li>Demonstrate excellent oral and written communication skills in order to effectively communicate with patients, physicians, peers, insurance companies and pharmacy personnel </li><li>Have a broad knowledge of medical terminology </li><li>Have the ability to prioritize and multi-task and must be able to function in a fast paced, at times, stressful environment </li><li>Be able to function independently and as part of a team </li><li>Proficient in EPIC </li></ul> <p>Education and Experience:</p> <ul> <li>High school diploma or equivalent </li><li>At least 2 years related experience required </li></ul> <p>Qualifications</p> <p>Qualifications</p> <p>Education: High School diploma or GED.</p> <p>Experience: Minimum of two (2) years of pre-certification experience required.</p> <p>Requirements for Level I Status:</p> <ul> <li>Entry level (1-4 years' experience) and/or meet the basic requirements of the job with the need for additional supervision. </li><li>Excess of 4 years' experience if meeting only the basic requirements of the job with need for additional supervision. </li></ul> <p>Additional Qualifications: Proficient knowledge of medical terminology, ICD-10 and CPT-4 codes.</p> <p>Performance Requirements:</p> <ul> <li>Excellent communication skills, both written and verbal. </li><li>Proficient technical (computer) skills. </li><li>Ability to multi-task and prioritize. </li><li>Self-motivated with initiative. </li><li>Strong sense of ethics. </li></ul> <p>Equipment Operated: This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.</p> <p>Work Environment: This job operates in professional office environments.</p> <p>Physical Requirements: While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.</p> <p>GI Alliance is an Equal Opportunity Employer. We are committed to creating an inclusive, welcoming, and equitable work environment. Our company values and celebrates the diversity of our physicians, staff and patients. We firmly believe our service is greatly enriched by our diversity of thought, experience, perspective, culture, and background.</p> <p>Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.</p> <p>NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.</p> <p>No phone calls or agencies, please.</p> <p>EEO/AA-M/F/disabled/protected veteran</p>