Precertification Specialist

Overview

Join RCCA and make a meaningful impact on the patient journey. As a fully remote Precertification Specialist, you will be responsible for obtaining and managing prior authorizations to ensure patients receive timely access to the care and treatment they need. This role requires strong attention to detail, problem-solving skills, and a commitment to delivering exceptional service while navigating complex insurance requirements. 

Employment Type: Full Time

Location: Teaneck, NJ (Remote)

Compensation: $18.99 - $29.22 hour

Compensation packages based on your unique skills, experience, and qualifications

As of the date of this posting, RCCA offers a comprehensive benefits package for this position, subject to eligibility requirements. In addition to the salary, we provide: Health, dental, and vision plans, Wellness program, Health savings account - Flexible spending accounts, 401(k) retirement plan, Life insurance, Short-term disability insurance, Long-term disability insurance, Employee Assistance Program (EAP), Paid Time Off (PTO) and holiday pay, Tuition discounts with numerous universities.

We believe these benefits underscore our commitment to the well-being and professional growth of our employees.

Responsibilities

• Under general supervision, the Precertification Specialist is responsible for ensuring that prior authorizations are obtained in a timely manner and remain current, facilitating uninterrupted patient care.
• Reviews and confirms patient insurance eligibility, benefits, and coverage for specific services, ensuring alignment with payer requirements
• Follows standard operating procedures and established guidelines to complete tasks related to prior authorization, ensuring that all insurance requirements are met in a compliant and accurate manner
• Proactively follows up with insurance carriers on pending or denied authorizations, submitting appeals when necessary
• Resolves any issues or discrepancies related to prior authorization requests
• Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards and US Oncology's Shared Values.
• Monitors assigned worklists and emails to provide front-end review for authorization and to answer any questions related to authorizations.
• Contacts patients to discuss OOP cost,offer assistance options (if available), and coordinate outreach for patient plan initiation (if applicable). 
• Reviews weekly denialreport and resolves issues, including submitting retro authorization requests or front-end appeals. 
• Adheres to workflow and, if issues arise, escalates to Supervisor promptly.
• Adheres to confidentiality and all state, federal, and HIPAA laws and guidelinesregarding patient records. 
• Performs other duties as requested or assigned.

Qualifications

• High School diploma or equivalent required
• Minimum two (2) years of experience in a patient access or financial clearance role. Oncology preferred.
• Demonstrate advanced knowledge of medical terminology
• Ability to navigate different systems seamlessly and able to multitask efficiently.
• Must successfully complete required e-learning courses within 90 days of occupying position

COMPETENCIES

Technical and Functional Expertise

• Maintains current knowledge of healthcare reimbursement, insurance authorization requirements, industry standards, and applicable regulations.
• Applies technical knowledge and established processes to ensure accurate and timely completion of prior authorization activities.
• Effectively utilizes available tools, systems, and resources to support operational goals and patient needs.

Adaptability and Resilience

• Demonstrates flexibility and adaptability in a fast-paced healthcare environment.
• Effectively manages multiple priorities while maintaining accuracy and attention to detail.
• Responds positively to changing business needs, shifting priorities, ambiguity, and organizational change.
• Maintains composure and productivity when faced with challenges, setbacks, or competing demands.

Customer Service Excellence

• Builds and maintains positive working relationships with patients, physicians, coworkers, supervisors, insurance carriers, and other external partners.
• Communicates professionally, respectfully, and effectively to support positive patient experiences and successful team collaboration.
• Demonstrates a service-oriented approach that promotes patient satisfaction and operational excellence.

Judgment and Decision-Making

• Exercises sound judgment when evaluating information, resolving issues, and determining appropriate courses of action.
• Makes timely, accurate, and cost-effective decisions while ensuring compliance with organizational policies and payer requirements.
• Demonstrates the ability to make informed decisions in situations involving uncertainty or limited information.

Accountability and Work Commitment

• Takes ownership of responsibilities and follows through on commitments.
• Establishes and maintains high standards of performance and professionalism.
• Demonstrates initiative and a strong commitment to achieving individual and departmental goals.
• Works efficiently and effectively to meet productivity, quality, and service expectations.

Quality and Continuous Improvement

• Consistently delivers high-quality work and services with a focus on accuracy and compliance.
• Supports and promotes quality standards across all aspects of job performance.
• Identifies opportunities to improve workflows, enhance operational effectiveness, and increase efficiencies.
• Contributes to continuous improvement efforts that support exceptional patient care and organizational success.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to manipulate a computer keyboard and mouse. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment. Involves frequent contact with staff. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to blood, toxic substances, ionizing radiation and other conditions common to a clinic environment.