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 patient`s 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 varied 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 Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties Qualifications High School diploma or equivalent required

Medical terminology knowledge required

Minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations

Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere

Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes

Ability to work well individually and in a team environment

Strong organizational and task prioritization skills

Experience with GE Centricity or EPIC PB preferred

Strong communication skills/oral and written

Strong organizational skills

Proficiency in Microsoft Office Suite Strong interpersonal skills,



ability to communicate well at all levels of the organization Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses High level of integrity and dependability with a strong sense of urgency and results oriented Excellent written and verbal communication skills required Gracious and welcoming personality for customer service interaction Working Conditions Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.

Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

Work Environment: The noise level in the work workplace is usually minimal. Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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