About Company:
Our Commitment to the Gwinnett Community
At Suburban Hematology Oncology Associates, our mission is to provide world-class, cutting-edge care right here in Gwinnett County. With five convenient locations and a dedicated team of 15 medical professionals, we combine advanced clinical expertise with a deeply compassionate, patient-centered approach. We invite you to experience the difference that personalized, community-focused care can make.
Comprehensive Hematology & Oncology Services
We are proud to offer a full spectrum of specialized care for our patients. Each of our five state-of-the-art facilities features a fully staffed, on-site laboratory equipped to handle your diagnostic needs with precision and speed.
Our board-certified oncologists and hematologists specialize in treating a wide range of conditions, including:
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Blood-Related Cancers and Marrow Failure.
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Acute and Chronic Blood Conditions, such as anemias.
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Bleeding and Clotting Disorders.
Whether you are navigating a new diagnosis or managing a chronic condition, our team is here to provide the highest standard of care at every step of your journey.
About the Role:
The Billing Department - Pre-Certification Specialist plays a critical role in ensuring that all medical services requiring prior authorization are properly reviewed and approved before delivery. This position is responsible for coordinating with healthcare providers, insurance companies, and patients to obtain necessary pre-certifications, thereby minimizing claim denials and delays in billing. The specialist will meticulously verify insurance benefits, interpret policy requirements, and maintain accurate documentation to support billing processes. By proactively managing pre-certification workflows, this role directly contributes to the financial health of the organization and enhances patient satisfaction through timely service delivery. The ideal candidate will be detail-oriented, communicative, and adept at navigating complex insurance protocols to facilitate seamless billing operations.
Minimum Qualifications:
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High school diploma or equivalent; associate degree or higher preferred.
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Minimum of 1-2 years experience in medical billing, insurance verification, or pre-certification processes.
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Strong knowledge of medical terminology and healthcare insurance policies.
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Proficiency with electronic health records (EHR) systems and billing software.
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Excellent communication and organizational skills.
Preferred Qualifications:
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Certification in medical billing or coding (e.g., CPC, CCA) is advantageous.
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Experience working with multiple insurance carriers and familiarity with Medicare and Medicaid requirements.
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Ability to analyze and interpret complex insurance policies and payer guidelines.
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Prior experience in a hospital or clinical setting.
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Advanced proficiency in Microsoft Office Suite and data management tools.
Responsibilities:
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Review and process pre-certification requests for medical procedures, tests, and treatments in accordance with insurance guidelines.
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Communicate effectively with healthcare providers, insurance representatives, and patients to gather and verify necessary information.
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Maintain accurate records of all pre-certification activities and ensure compliance with regulatory and organizational policies.
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Monitor authorization status and follow up on pending or denied requests to resolve issues promptly.
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Collaborate with the billing and coding teams to ensure that pre-certification information is accurately reflected in patient billing.
Skills:
In this role, strong communication skills are essential for liaising between patients, providers, and insurance companies to ensure clear and accurate information exchange. Attention to detail is critical when reviewing insurance policies and documentation to prevent errors that could delay authorization or billing. Organizational skills help manage multiple pre-certification requests simultaneously while maintaining compliance with deadlines and regulations. Proficiency with EHR and billing software enables efficient processing and tracking of authorizations, reducing administrative burdens. Additionally, analytical skills support the interpretation of complex insurance requirements, allowing the specialist to resolve issues and optimize the pre-certification workflow effectively.
