Job Purpose
The Pre-Certification Representative is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies.
Duties and Responsibilities
Works effectively with insurance companies to obtain pre-certification for services
Places calls to various health plans to obtain appropriate precertification prior to the patients appointment
Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
Faxes to pre-certification request form to insurance company
Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
Verifies medical insurance information and documents in scheduling/registration modules
Reviews claim denials and rejections
Accurately enters and updates patient data, and other general data, into the computer system
Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics




Demonstrates knowledge of diverse managed care insurance and regulatory guidelines
Meets and maintains daily productivity/quality standards established in departmental policies
Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts
Adheres to the policies and procedures established for the client/team
Communicate effectively with physician offices and patients
Place outbound call to patients with precertification notification
Work independently from assigned work queues
Maintain confidentiality at all times
Maintain a professional attitude
Other duties as assigned by the management team
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Understand and comply with Information Security and HIPAA policies and procedures at all times
L

📌 Pre-Certification Representative (Chennai)
🏢 Med-Metrix
📍 Chennai