Precertification Specialist for Value-Based Care

Position Summary

Reasons you will want this position:

• We are a rapidly growing company, which offers limitless career growth and advancement for top performers
• Our culture rewards and appreciates employees especially those with creative ideas that achieve better outcomes for everyone, which is why many of our employees have been with us for more than 20 years
• Offer a variety of benefits including medical, dental, vision, FSA, HSA, ST/LT disability, Life Insurance, tuition assistance, 401K with employer contributions vesting immediately, and more
• This is a key position to our continued success and growth from new clients onboarding
• Hybrid Remote work schedule with flexible hours in our brand-new office space

Summary
As the Precertification Specialist, you will be responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. You will be the liaison between the insurance companies and physician's offices, verify insurance eligibility and benefits, and obtain precertification/preauthorization for procedures, diagnostic testing, and office visits. You will also be expected to meet productivity and documentation guidelines set by Cedar Gate Technologies and our clients.

Roles & Responsibilities

• Accurately complete all fields in the patient demographic and insurance screens within the computer system.
• Call the patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.
• Attempt to obtain and document in the computer system referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
• Obtain and document in the computer system the precertification/preauthorization number from insurance companies prior to each surgical procedure and diagnostic test.
• Assist patients with scheduling new patient office visits with CVCP provider offices.
• Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.
• Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline.
• Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute the list to precertification staff for processing.
• Correct any account in which errors have occurred per the assigned deadline.
• Maintain constant communication among the physician, insurance company, and CVCP regarding authorization and the CVCP authorization status on patients.
• Maintain a minimum average of 30 CVCP authorizations per day with proven accuracy after 3 months.

Required Experience / Qualifications

• Minimum 2 years of experience in working in precertification
• Working knowledge of managed care in all areas, most notably: referrals, insurance verification, and precertification.
• Knowledge of medical terminology
• Familiarity with ICD-9 and ICD-10
• Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bill
• Detail-oriented and strong critical thinking skills for solving problems on your own
• Ability to perform multiple tasks simultaneously and problem solve efficiently
• Excellent organizational and interpersonal skills
• Strong desire to learn and utilize technology effectively
• Some experience with Microsoft Office including Teams
• Quickly able to enter data accurately and understand the information entered
• Flexibility to work overtime occasionally, typically when onboarding new clients

Your Future Working Environment

If you join Cedar Gate, you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide ongoing training that builds and extends professional, technical, and management skills in all areas. At Cedar Gate, you will operate in a professional environment where teamwork and innovation are immensely encouraged. Together with colleagues, you will work on high-impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate enables payers, providers, employers, and service administrators to excel at value-based care. Our unified technology and services platform enhances and automates data management activities to deliver employer and provider analytics, care management, and payment technology necessary to pursue every payment model and optimize performance in all lines of business. From primary care attribution to bundled payments to capitation, our platform is designed to improve clinical, financial, and operational outcomes for all.

Based in Greenwich, CT, Cedar Gate is private equity-backed by GTCR, a leading Chicago-based private equity firm, Ascension Ventures, a strategic healthcare venture firm, and Cobalt Ventures, the investment subsidiary of BCBS of Kansas City. To learn more, visit www.cedargate.com.