Pre-Certification Representative

Med-Metrix

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

Posted 10/16/2026full-timeRemote • Washington • 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 regulations. Proficient in medical terminology and adept at utilizing healthcare systems to manage patient data and communications effectively.

Highest-signal resume keywords

Pre-Certification ManagementMedical Terminology KnowledgeInsurance VerificationExperience With GE CentricityProficiency In Microsoft Office Suite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pre-CertificationInsurance VerificationCPT CodesDiagnosis CodesData EntryClaim Denial ReviewPatient IntakeTask PrioritizationMedical DocumentationConfidentiality Compliance

Soft Skills

Strong Communication SkillsOrganizational SkillsInterpersonal SkillsProblem Solving SkillsSound Judgment

Tools & Technologies

MPowerGE CentricityEPIC PBEviCoreNavinetNovitasphere

Industry Keywords

HealthcarePre-AuthorizationHIPAA CompliancePatient Data ManagementInsurance 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 confidential files and scan/input data using the host system
Verify medical insurance information and documents in scheduling/registration modules
Review claim denials and rejections
Enter and update patient and other data in the computer system
Perform patient intake, insurance verification, copay/patient liability notification, and demographic confirmation
Use MPower, client host systems, and other tools to collect payments and resolve accounts
Communicate with physician offices and patients
Place outbound calls to patients regarding precertification notifications
Work independently from assigned work queues
Maintain confidentiality and comply with HIPAA and information security policies
Meet departmental productivity and quality standards
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
Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
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 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
Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes