Pre-Certification Representative

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Med-Metrix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2010

🏥 Healthcare

☁️ SaaS

💰 Private equity on 2025-09

Healthcare • SaaS

Med-Metrix is a company for which only a minimal web presence was provided (the page only displayed "Loading application... Your web browser must have JavaScript enabled... "). No product, market, or mission details were included in the supplied text. Based on the company name alone, it plausibly focuses on medical or clinical metrics, analytics, or healthcare software, but that is speculative and not confirmed by the provided information. Further public details would be required to be more specific.

📋 Description

• Obtain and provide accurate and complete data input for precertification/preauthorization from insurance companies • Work with insurance companies to obtain pre-certification for services • Call health plans to obtain precertification before patient appointments • Interpret documented clinical information and relay pertinent medical/clinical information to insurance companies • Fax pre-certification request forms to insurance companies • Maintain files and security of confidential information using host systems to scan and input data • Verify medical insurance information and documents in scheduling/registration modules • Review claim denials and rejections • Enter and update patient and general data in computer systems • Perform patient intake, insurance verification, copay/patient liability notification, and demographic confirmation • Use MPower workflow, client host systems, and other tools to collect payments and resolve accounts • Communicate with physician offices and patients • Make outbound calls to patients regarding precertification notifications • Work independently from assigned work queues • Maintain confidentiality and comply with HIPAA and PHI requirements • Meet daily productivity and quality standards • Follow client/team policies and procedures • Perform other duties assigned by management

🎯 Requirements

• 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 required • Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere required • 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 • Proficiency in Microsoft Office Suite • Strong interpersonal skills and ability to communicate well at all levels of the organization • Strong problem-solving and creative skills, with 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 orientation • Excellent written and verbal communication skills required • Gracious and welcoming personality for customer service interaction • Ability to follow directions, collaborate with others, and handle stress • Must be able to perform the listed physical demands, including sitting, manual tasks, operating office equipment, extending arms, kneeling, talking, and hearing • Must understand and comply with Information Security and HIPAA policies and procedures

🏖️ Benefits

• Remote work • Use of a smartphone or electronic device for multifactor authentication and security purposes