Pre-Certification Representative

Med-Metrix

. Obtain and provide accurate and complete data input for precertification/preauthorization from insurance companies .

Posted 10/13/2026full-timeRemote • New Jersey • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in obtaining pre-certifications and handling insurance verifications while maintaining compliance with HIPAA and PHI requirements. Proficient in medical terminology, CPT codes, and utilizing healthcare systems to ensure accurate data management and communication.

Highest-signal resume keywords

Pre-Certification ManagementMedical Terminology KnowledgeInsurance VerificationExperience with GE Centricity or EPIC PBProficiency in Microsoft Office Suite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pre-Certification ManagementMedical TerminologyCPT CodesDiagnosis CodesInsurance VerificationData EntryClaim ReviewPatient IntakePayment CollectionConfidentiality Compliance

Soft Skills

Strong Communication SkillsOrganizational SkillsInterpersonal SkillsProblem-Solving SkillsAbility to Work Independently

Tools & Technologies

MPower WorkflowClient Host SystemsGE CentricityEPIC PBEviCoreNavinetNovitasphere

Industry Keywords

HealthcarePre-AuthorizationHIPAA CompliancePHI ComplianceInsurance Companies

About the role

Key responsibilities & impact

Obtain and provide accurate and complete data input for precertification/preauthorization from insurance companies
Work with insurance companies to obtain pre-certification for services
Call health plans to obtain precertification before patient appointments
Interpret documented clinical information and relay pertinent medical/clinical information to insurance companies
Fax pre-certification request forms to insurance companies
Maintain files and security of confidential information using host systems to scan and input data
Verify medical insurance information and documents in scheduling/registration modules
Review claim denials and rejections
Enter and update patient and general data in computer systems
Perform patient intake, insurance verification, copay/patient liability notification, and demographic confirmation
Use MPower workflow, client host systems, and other tools to collect payments and resolve accounts
Communicate with physician offices and patients
Make outbound calls to patients regarding precertification notifications
Work independently from assigned work queues
Maintain confidentiality and comply with HIPAA and PHI requirements
Meet daily productivity and quality standards
Follow client/team policies and procedures
Perform other duties assigned by management

Requirements

What you’ll need

High School diploma or equivalent required
Medical terminology knowledge required
Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations required
Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere required
Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
Ability to work well individually and in a team environment
Strong organizational and task prioritization skills
Experience with GE Centricity or EPIC PB preferred
Strong communication skills/oral and written
Proficiency in Microsoft Office Suite
Strong interpersonal skills and ability to communicate well at all levels of the organization
Strong problem-solving and creative skills, with the ability to exercise sound judgment and make decisions based on accurate and timely analyses
High level of integrity and dependability, with a strong sense of urgency and results orientation
Excellent written and verbal communication skills required
Gracious and welcoming personality for customer service interaction
Ability to follow directions, collaborate with others, and handle stress
Must be able to perform the listed physical demands, including sitting, manual tasks, operating office equipment, extending arms, kneeling, talking, and hearing
Must understand and comply with Information Security and HIPAA policies and procedures

Benefits

Comp & perks

Remote work
Use of a smartphone or electronic device for multifactor authentication and security purposes