Pre-Certification Specialist

AMI is seeking a Full-Time Pre-Certification / Pre-Service Representative to join the team. This remote position will include on-site training at the corporate office in West Atlantic City.

AMI offers a generous compensation and benefits package including medical, prescription, dental, vision, flexible spending accounts, Paid Time Off (PTO), Paid Holidays, 401k and Profit sharing and the opportunity to work in an exciting and progressive outpatient practice. Offered rates increase based on years of work experience.

The Pre-Certification / Pre-Service Specialist is responsible for ensuring that all outpatient insurance requirements are completed in advance of patient’s scheduled appointment date. The team works directly with AMI's referring provider offices.

• Evaluates patient’s scheduled procedures to determine if prior authorization is required.
• Reviews and validates patient insurance information to confirm coverage for scheduled procedures, leveraging a strong understanding of insurance plans and their specific provisions.
• Monitors authorization request, follows up with payers, and records all communications regarding insurance claims.
• Reviews insurance denials, resubmits claims, and submits appeals as necessary to ensure patients obtain required care.
• Ensures patient insurance eligibility is verified and authorizations are obtained through insurance portals (e.g., Evicore, etc.) on behalf of physician practices registered with the AMI Pre-Authorization Service, when applicable, prior to the patient’s scheduled procedure or testing date.
• Communicates updates in pre-authorization procedures to management to keep the pre-certification manual accurate and current. Documents denial reasons and contributing factors to ensure team alignment with industry standards.
• Maintains an up-to-date list of facility insurance pre-certification agreements.
• Other duties as assigned.

This Full time, 40 hour per week position is remote and includes a work schedule of Monday-Friday, 8:30am-5pm. Candidates must be able to travel to AMI offices for initial training, occasional meetings, and ongoing training.

Qualifications

Candidates must have a high school diploma or equivalent, with at least 2 years' experience with insurance coverage verification in a medical practice or healthcare setting; radiology practice experience is a plus. Intermediate computer skills, with a working knowledge of the Microsoft Office Suite is required. Candidates must have experience with online medical insurance portals. A demonstrated knowledge of insurance plans and the authorization process is required. A knowledge of and familiarity with medical terminology, ICD-10, and CPT coding is strongly preferred.

Additionally, candidates must have the ability to remain highly organized with accounts, work independently, and receive & implement direction as provided, with minimal supervision. The ability to remain detail oriented while managing a high volume of requests is required.

Exceptional interpersonal skills, verbal & written communication, and customer service skills are required for success in this position. These skills must be maintained in a fast-paced environment, while maintaining a professional demeanor and providing exceptional service to patients and referrers.

AMI offers a generous compensation and benefits package including medical, prescription, dental, vision, flexible spending accounts, Paid Time Off (PTO), Paid Holidays, 401k and Profit sharing and the opportunity to work in an exciting and progressive outpatient practice. Offered rates increase based on years of work experience.

EOE