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PreAuth/PreCert Specialist - Cardiology

Danville, Virginia

Req ID 7455-13338 Post Date Apr. 22, 2025 CategoryAdministrative FacilitySovah Health - Danville
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Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. SOVAH Health - Danville is a 250 bed hospital with the region's only designated Chest Pain Center & Certified Advanced Primary Stroke Center. We are an academic teaching site for residents, medical students, nurses, nurse practitioners, pharmacists, and physician assistants.
Where We Are:
From our beautiful rolling countryside to our thriving downtown, Danville offers big city amenities with quaint, small town charm. We are home to a thriving arts and entertainment scene, numerous local restaurants and shops, diverse educational institutions, and vast recreational opportunities. 
Why Choose Us:
·    Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
·    Competitive Paid Time Off / Extended Illness Bank package for full-time employees
·    Employee Assistance Program – mental, physical, and financial wellness assistance
·    Tuition Reimbursement/Assistance for qualified applicants
·    Professional development, Growth opportunities, and Mentor-based training
·    And much more…
Position Summary:
Sovah Health is looking for the ideal candidate who will serve as the liaison between the physicians; the insurance companies; and the patients. Gathers information from the physicians, patients, and insurance companies and enters into the computer system to create an electronic record. Obtains prior authorizations from insurance companies for procedures, medications, and tests.
•    Obtains prior authorizations from insurance companies for procedures, medications, and tests.
•    Verifies patient information, diagnoses, and past medical history prior to contacting insurance company.
•    Handles face to face inquires and questions from patients regarding forms, account status, medical records, and authorization status.
•    Obtains necessary physician and patient signatures as required.
•    Completes pre-certifications with insurance companies for procedures, laboratory tests, x-rays, and ultrasound tests as required by third party insurance protocols.
•    Answers incoming calls from insurance companies, physician offices and from patients regarding forms completion, pre-cert and pre-auth status, account balances in both old and new accounting systems.
•    Receives medical records requests from insurance companies, patients, and physicians and coordinates records reproduction with a third party medical records reproduction firm.
•    Responds to subpoenas for medical records from attorneys and insurance companies; copies and faxes urgent medical records requests.
•    As requested, collects co-pays, deductibles, payments and assists patients with account balances, and accepts telephone payments via credit cards.
•    Follows through on MD orders by providing work excuses, obtaining medical records, completing disability forms, FMLA forms DME requests, and DMV forms
Minimum Qualifications:
Minimum Education
High school diploma or equivalent is Required
Medical terminology, CPT coding, ICD-9 coding
Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Certifications: . Medical terminology, CPT coding, ICD-9 coding
Licenses: N/A
Working with the public. Basic computer and typing skills required. Fulfills other assigned responsibilities, duties, and tasks not specifically listed within this job description and as directed by employee’s supervisor.
Minimum Work Experience
Medical office experience preferred. 2-4 years Office functions with experience


Minimum Qualifications:
Minimum Education
High school diploma or equivalent is Required
Medical terminology, CPT coding, ICD-9 coding
Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Certifications: . Medical terminology, CPT coding, ICD-9 coding
Licenses: N/A
Working with the public. Basic computer and typing skills required. Fulfills other assigned responsibilities, duties, and tasks not specifically listed within this job description and as directed by employee’s supervisor.
Minimum Work Experience
Medical office experience preferred. 2-4 years Office functions with experience

EEOC Statement:
SOVAH Health - Danville is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.


Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran
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