Pyramid Consulting, Inc · 2 days ago
Pre-Certification Specialist.
Lake Mary, FL
Contract
Remote
Entry Level
$20/hr - $21/hr
1+ years exp
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Responsibilities
Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal.
Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate).
Determine authorization requirements based on company policy, member benefit grid and provider status.
Review customer coverage and benefits.
Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse).
Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
Professional demeanor and the ability to work effectively within a team or independently.
Flexible with the ability to shift priorities when required.
Maintains regular and acceptable attendance in accordance with Time Away From Work policy.
Ability to work evening, weekend and holiday shifts to support the UM Department.
Other duties as requested.
Qualification
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Required
Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal.
Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate).
Determine authorization requirements based on company policy, member benefit grid and provider status.
Review customer coverage and benefits.
Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse).
Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
Professional demeanor and the ability to work effectively within a team or independently.
Flexible with the ability to shift priorities when required.
Maintains regular and acceptable attendance in accordance with Time Away From Work policy.
Ability to work evening, weekend and holiday shifts to support the UM Department.
Key Skills: Medical Terminology, Managed care environment, call center.
Proficient in medical terminology, CPT, HCPCS and ICD-10 coding.
Effective oral and written communication skills.
Strong customer orientation.
Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word.
Excellent typing skills.
Previous call center/phone queue experience required.
Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer.
Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment.
Proficient knowledge of departmental policies and procedures.
Knowledge of Medicare Regulatory Requirements.
Previous experience working in a remote environment.
High School Diploma and preferred 1-2 years’ experience in a managed care environment.
Benefits
Health insurance (medical, dental, visiocin)
401(k) plan
Paid sick leave
Company
Pyramid Consulting, Inc
Pyramid Consulting, a global leader in workforce and technology solutions, empowers individuals and organizations to transform and thrive in the most challenging and competitive markets.
5,001-10,000 employees
H1B Sponsorship
Pyramid Consulting, Inc has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (77)
2022 (60)
2021 (62)
2020 (93)
Funding
Current Stage
Late StageLeadership Team
Sanjeev Tirath
Founder & CEO
Recent News
Atlanta Business Chronicle
2023-11-09
Company data provided by crunchbase
