Talent.com
PRISM Vision Group
Precertification SpecialistPRISM Vision Group • Teaneck, NJ, United States
Precertification Specialist

Precertification Specialist

PRISM Vision Group • Teaneck, NJ, United States
2 days ago
Salary
$18.99–$29.22 hourly
Job type
  • Full-time
Job description

Precertification Specialist

Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining and managing prior authorizations to ensure patients receive timely access to the care and treatment they need. This role requires strong attention to detail, problem-solving skills, and a commitment to delivering exceptional service while navigating complex insurance requirements.

Employment Type: Full Time

Location: Teaneck, NJ (Remote)

Compensation: $18.99 - $29.22 hour

Compensation packages based on your unique skills, experience, and qualifications

As of the date of this posting, RCCA offers a comprehensive benefits package for this position, subject to eligibility requirements. In addition to the salary, we provide: Health, dental, and vision plans, Wellness program, Health savings account - Flexible spending accounts, 401(k) retirement plan, Life insurance, Short-term disability insurance, Long-term disability insurance, Employee Assistance Program (EAP), Paid Time Off (PTO) and holiday pay, Tuition discounts with numerous universities.

We believe these benefits underscore our commitment to the well-being and professional growth of our employees.

Responsibilities

  • Under general supervision, the Precertification Specialist is responsible for ensuring that prior authorizations are obtained in a timely manner and remain current, facilitating uninterrupted patient care.
  • Reviews and confirms patient insurance eligibility, benefits, and coverage for specific services, ensuring alignment with payer requirements
  • Follows standard operating procedures and established guidelines to complete tasks related to prior authorization, ensuring that all insurance requirements are met in a compliant and accurate manner
  • Proactively follows up with insurance carriers on pending or denied authorizations, submitting appeals when necessary
  • Resolves any issues or discrepancies related to prior authorization requests
  • Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and US Oncology's Shared Values.
  • Monitors assigned worklists and emails to provide front-end review for authorization and to answer any questions related to authorizations.
  • Contacts patients to discuss OOP cost, offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable).
  • Reviews weekly denial report and resolves issues, including submitting retro authorization requests or front-end appeals.
  • Adheres to workflow and, if issues arise, escalates to Supervisor promptly.
  • Adheres to confidentiality and all state, federal, and HIPAA laws and guidelines regarding patient records.
  • Performs other duties as requested or assigned.

Qualifications

  • High School diploma or equivalent required
  • Minimum two (2) years of experience in a patient access or financial clearance role. Oncology preferred.
  • Demonstrate advanced knowledge of medical terminology
  • Ability to navigate different systems seamlessly and able to multitask efficiently.
  • Must successfully complete required e-learning courses within 90 days of occupying position
Create a job alert for this search

Precertification Specialist • Teaneck, NJ, United States

Similar jobs

Credentialing Specialist

Essen Medical AssociatesBronx, NY, United States
Full-time

The Credentialing Specialist is responsible to coordinate and assist with the day-to-day administrative functions of the Department.The selected candidate will have excellent written communication ... Show more

 • Promoted

Quality Specialist Technologist - Anatomic Pathology/Histology

NeoGenomicsRamsey, NJ, United States
Full-time

Anatomic Pathology Quality Specialist Technologist.Are you motivated to participate in a dynamic, multi-tasking environment? Do you want to join a company that invests in its employees? Are you see... Show more

 • Promoted

Specialist, Audit & Compliance

CMI Media GroupNew York, NY, United States
Full-time

Specialist, Audit & Compliance.At CMI Media Group, we are delivering healthcare marketing at the speed of life.Our success is built on innovation, collaboration, and a relentless commitment to exce... Show more

 • Promoted

Youth Development Specialist - Relocation to Hershey, PA Required

Milton Hershey SchoolPeekskill, New York, United States
Full-time

Located in Hershey, PA, Milton Hershey School (MHS) is a top-notch home and school where over 2,200 pre-K through 12th grade students from disadvantaged backgrounds are provided an extraordinary, c... Show more

 • Promoted

Community Habilitation Specialist

YAIBronx, NY, United States
Full-time +1

Community Habilitation Staff Member.YAI is seeking a creative, passionate, and highly motivated professional for our Community Habilitation services in New York City.As a Community Habilitation sta... Show more

 • Promoted

Certified Medical Assistant - Croton

CareerNationCroton On Hudson, NY, United States
Full-time

Our client is one of the largest network of medical groups in the nation, offering an excellent compensation and benefits package including:.A robust retirement plan with employer matching.Comprehe... Show more

 • Promoted

Performance Marketing Automation Specialist

ConnectOne BankEnglewood Cliffs, NJ, United States
Full-time

Marketing Operations Team Member.Become an integral member of the Marketing Operations team at ConnectOne Bank! This hands-on, tactical position is critical to scaling our efforts by owning digital... Show more

 • Promoted

13B Cannon Crewmember - Weapons Systems Technician

Army National GuardNew Windsor, NY
Part-time

As a Cannon Crewmember in the Army National Guard, you join a team that ensures the U.You’ll deliver decisive blows to the enemy using howitzers and learn how to use high-tech cannon artillery weap... Show more

 • Promoted

Credentialing Specialists

Armada LtdNew Windsor, NY, United States
Full-time

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports throu... Show more

 • Promoted

Digital Commerce Content Specialist

AriZona Beverage Co.Woodbury, NY, United States
Full-time

Digital Marketplace Content Specialist.AriZona Beverages, founded in Brooklyn, N.AriZona's mission is to offer top quality beverages in uniquely designed packages that are accessible and affordable... Show more

 • Promoted

Senior Specialist - Client Events, US

Latham & WatkinsNew York, NY, United States
Full-time

Senior Specialist - Client Events, US.The Senior Specialist - Client Events, US is an integral part of Latham's Events, Sponsorship and Travel team.This role will be responsible for executing a hig... Show more

 • Promoted

Recertification Specialist

HANAC IncAstoria, NY, United States
Full-time

George Douris as the Hellenic American Neighborhood Action Committee, is a New York City-based multi-faceted social services organization.The organization was founded in 1972 to serve the needs of ... Show more

 • Promoted

Special Projects Fellow (PT, Temp)

Fund for Public Health in NYCNew York, NY, United States
Full-time

WorkWell NYC seeks an independent and highly motivated Special Projects Fellow to provide support for a variety of worksite wellness initiatives that aim to improve the health and well-being of Cit... Show more

 • Promoted

Certified Nursing Assistant

StateJobsNYMontrose, NY, United States
Full-time +1

Occupational Category: Health Care, Human/Social Services.Bargaining Unit: ISU - Institutional Services Unit (CSEA).Salary Range: From $55735 to $59743 Annually.Jurisdictional Class: Non-competitiv... Show more

 • Promoted

Precertification Specialist

US Oncology Network-wide Career OpportunitiesTeaneck, NJ, United States
Full-time

Overviewoin the team at Regional Cancer Care Associates as a Precertification Specialist, where your passion and multi-tasking prowess will directly impact patient lives! Be the vital link in secur... Show more

 • Promoted

Work From Home - Product Specialist - $45 per hour

GL1Mount Ivy, New York
$45.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Implementation Specialist

CureMDNew York, NY, United States
Full-time

CureMD Implementation Specialist.A CureMD Implementation Specialist (IS) leads the implementation process to successfully onboard medical offices onto CureMD's suite of services, including Practice... Show more

 • Promoted

Quality Improvement and Compliance Specialist

Program DevelopmentBrooklyn, NY, United States
Full-time

Quality Improvement and Compliance Specialist.NeuSpark PDS provides person-centered, community-based supports for individuals with developmental disabilities.Through a range of residential, day, an... Show more

 • Promoted

Medical Assistant

DOCS HealthCortlandt Manor, NY, United States
Full-time

Attention all Medical Assistants we are calling on you to partner with us to provide services to our Military Service members.We will primarily work weekends, with some occasional weekdays in the S... Show more

 • Promoted

Senior Specialist, Plan Design

VestwellNew York, NY, United States
Temporary

Senior Specialist, Plan Design.Vestwell is the financial technology company powering the new savings economy.Our platform redefines how people save for the critical aspects of life across retiremen... Show more