VBC Precertification Specialist at Cedar Gate Technologies (Houston, TX)

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Job Details


Job Location
Houston Office - Houston, TX

Remote Type

Position Type
Full Time

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Job Location

Houston, TX

Position Summary

The Precertification Specialist is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers.

Act as liaison between the insurance companies and physician's offices, verify insurance eligibility and benefits, and obtain pre-certification/ preauthorization for procedures, diagnostic testing, and office visits. Data enter CVCP Auths to meet productivity and documentation guidelines.

Roles & Responsibilities
  • Accurately complete all fields in the patient demographic and insurance screens within the computer system.
  • Call patient's insurance company to verify eligibility and obtain benefit coverage for office visits, outpatient tests, surgery, and inpatient admissions.
  • Attempt to obtain, and document in the computer system, referral details and referral modifications for specialty care and testing for patients with insurance plans requiring formal referral documentation.
  • Obtain and document in the computer system the pre-certification/pre-authorization number from insurance companies prior to each surgical procedure and diagnostic test.
  • Assist patients with scheduling new patient office visits with CVCP provider offices.
  • Create and distribute the CVCP Inpatient and Outpatient Service Lists and manifests to CVCP surgeons and consultants.
  • Complete all fields within the computer system necessary to process claims and re-route claims to the billing department per assigned deadline.
  • Distribute The Admit List daily by 1 p.m., identify possible CVCP patients, and distribute-list to pre-certification staff for processing.
  • Correct any account in which errors have occurred per the assigned deadline.
  • Maintain communication among the physician, insurance company, and CVCP at all times regarding authorization and CVCP Auth status on patients.
  • Maintain a minimum average of 30 CVCP Auths per day with proven accuracy after 3 months.
  • Work mandatory overtime, when needed.
  • Other duties and projects as assigned by management.


Required Experience / Qualifications
  • High school diploma required
  • Minimum 2 years of experience in precertification
  • Working knowledge of managed care in all areas, most notably: referrals, insurance verification, pre-certification.
  • Knowledge of medical terminology
  • Familiarity with ICD-9 and ICD-10
  • Computer systems and applications experience must have a working knowledge of Word, Excel, e-mail, and internet
  • Strong analytical skills with the ability to assess and analyze trends to determine the most effective approach to bill
  • Minimum 40 WPM keyboarding
  • Detail-oriented and strong critical thinking skills
  • Problem-solving
  • Ability to perform multiple tasks simultaneously and problem solve efficiently
  • Excellent organizational and interpersonal skills
  • Strong desire to learn and utilize technology effectively

Your Future Working Environment

If you join Cedar Gate you can make great ideas happen for some of the world's most dynamic companies. With broad global resources and deep technical know-how, we collaborate with clients to cultivate ideas and deliver results in the medical industry. Choose a career at Cedar Gate and enjoy an innovative environment where challenging and interesting work is part of daily life.

Next to our excellent terms of employment and fringe benefits, we invest considerable resources to provide on-going training that builds and extends professional, technical and management skills in all areas. At Cedar Gate you will operate in a professional environment where teamwork and innovation is immensely encouraged. Together, with colleagues you will work on high impact projects for many dynamic companies.

About Cedar Gate

Cedar Gate Technologies (Cedar Gate) is a leading value-based care performance management company founded in 2014 by David B. Snow Jr., a nationally recognized Fortune 50 CEO. Cedar Gate provides high-performance analytic, technological and advisory services to providers, payers and self-insured employers to enable them to meet and exceed the performance thresholds of value-based care contracts, networks and programs. Cedar Gate systems are helping clients realize value from over $91 billion of medical spend associated with risk-based contracts and programs that affect 3.2 million covered lives. Cedar Gate is the leading provider of prospective bundled payment solutions with 20+ years of experience and having processed more than 2.25 million distinct bundles.
More Information on Cedar Gate Technologies
Cedar Gate Technologies operates in the Information Technology industry. The company is located in Greenwich, CT, Houston, TX and Plano, TX. Cedar Gate Technologies was founded in 2014. It has 183 total employees. To see all jobs at Cedar Gate Technologies, click here.
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