Precertification Specialist

• Verify payor eligibility and update practice management system with corrections or changes as necessary.  Contact patient(s) who show ineligible for insurance coverage, confirm new coverage and update as required.  Inform patient of payment responsibility of uninsured.  Determine patient responsibility for office testing or procedures and communicate to patient to collect payment/arrange payment plan.
• Check patient(s) previous balances on each patient during verification. Contact patient to inform them of balance due at time of visit. 
• Verify PCP election accuracy and contact patient if PCP is inaccurate for resolution.  
• Process all necessary precertification requests for all diagnostic imaging, procedures and other special testing via telephone, fax and various external health plan websites.  
• Compile clinical data, including: physician notes, patient history, test results and other clinical information from Electronic Medical Record and other sources to respond to each payor’s precertification requirements.
• Coordinate peer-to-peer review with providers when required from payors for precertification. 
• Complete all FMLA, disability, sports, school, out of work and return to work forms in a timely manner.  
• Complete all HEDIS requests.
• Process all medical record requests from patients, insurance companies, attorneys, etc.  Inform request of fee, if applicable, and assure payment received prior to record release.
• Cover front desk as needed during vacation, sick calls, high patient volumes, etc.

• High School Diploma/GED equivalent 
• 3 years plus of current medical office experience
• Strong customer service
• Attention to detail
• Experience with working with Payors 
• Proficient in Microsoft Office Suite products

What We Offer: 

• Competitive salaries & benefits that start on day one!
• 403(b) retirement with company match
• Tuition reimbursement
• Free on-campus parking
• Guaranteed hours and set schedule

About Lowell General Hospital:
Lowell General Hospital is an independent, not-for-profit community hospital serving the Greater Lowell area and surrounding communities. With two primary campuses located in Lowell, Massachusetts, we are the second largest community hospital in Massachusetts. We have the latest state-of-the-art technology and a full range of medical and surgical services for patients, from newborns to seniors. We are also a proud member of Circle Health and in collaboration with the medical community it is our promise to provide our patients with Complete connected care ^SM