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Certification specialist skills for your resume and career

Updated January 8, 2025

5 min read

Below we've compiled a list of the most critical certification specialist skills. We ranked the top skills for certification specialists based on the percentage of resumes they appeared on. For example, 22.2% of certification specialist resumes contained patients as a skill. Continue reading to find out what skills a certification specialist needs to be successful in the workplace.

15 certification specialist skills for your resume and career

1. Patients

Here's how certification specialists use patients:

Interviewed patients to obtain complete and accurate demographic, financial and insurance information required for billing and collecting patient accounts.
Calculated amount owed for upfront payment expected by patients for upcoming procedures after Insurance was notified.

2. Medical Terminology

Here's how certification specialists use medical terminology:

Maintain continuing education on treatment and current medical terminology used in pre-certification used in the office.
Enter claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures.

3. Surgical Procedures

Surgical procedures include the list of tasks that are done while doing surgery. Usually, a surgical procedure involves an incision with instruments, performed to repair damage or heal the disease in a living body. Surgical procedures are performed by trained individuals such as surgeons, doctors, and nurses.

Here's how certification specialists use surgical procedures:

Obtained and secured prior authorization for testing and surgical procedures.
Process surgical procedures/medical services pre-certifications.

4. Medicaid

Here's how certification specialists use medicaid:

Perform observations on facilities and Medicaid enrolled providers relative to quality of medical services.
Conducted face to face interviews with clients to determine their eligibility for Food Stamps, Medicaid and cash assistance.

5. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how certification specialists use data entry:

Executed data entry of applications into Personify database.
Complete data entry of approved and denied authorizations in the medical management system on a daily basis.

6. Certification Process

Here's how certification specialists use certification process:

Provide technical expertise and training for Construction Project Administrators, District Materials Certification personnel and Final Estimates on the Certification process.
Write correspondences in response to letters and emails received in-house regarding certification process.

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7. HIPAA

Here's how certification specialists use hipaa:

Maintained confidentiality of patient information as per HIPAA guidelines.
Comply with all State WAC and Federal HIPAA requirements.

8. Insurance Benefits

Here's how certification specialists use insurance benefits:

Process all aspects of reimbursement by contacting payers, verifying insurance benefits and adhering to medical guidelines for reimbursement.
Verify insurance benefits and eligibility for every patient and create new patient information packets for initial visits.

9. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how certification specialists use cpt:

Verified assigned ICD9 and CPT codes were appropriate based on documentation in accordance with NCCN guidelines and Medicare approved.
Verified the ICD-10, CPT and/or HCPCS was payable under patient's insurance plan.

10. Insurance Verification

Here's how certification specialists use insurance verification:

Record insurance information to maintain data through the Referral/Insurance Verification process and communicates insurance information.
Verified and completed insurance verification.

11. NIST

Here's how certification specialists use nist:

Reviewed an Agency for compliance with IRS Publication 1075 that is aligned with NIST's special publication 800-53.
Naheed Vadsaria- Page 2 of 2 Reviewed and evaluated the DOT CIO IA Policies and NIST publications.

12. Insurance Coverage

Here's how certification specialists use insurance coverage:

Coordinated the collection of estimated patient liabilities, including co-payments and unmet deductibles and verified insurance coverage for provided patient services.
Verified insurance coverage and eligibility for each patient.

13. Outpatient Procedures

Here's how certification specialists use outpatient procedures:

Obtained pre-certification or authorization if required foal l outpatient procedures via website or direct call.
Review, evaluate verify and process assigned pre-certification requests for Outpatient procedures.

14. Patient Eligibility

Here's how certification specialists use patient eligibility:

Re-verified patient eligibility on a monthly basis.
Process applications and prescriptions, coordinate, track and maintain patient eligibility for program using established guidelines.

15. Insurance Eligibility

Here's how certification specialists use insurance eligibility:

Verify insurance eligibility for outpatients at least every 90 days and annually via electronic medical record and insurance websites.
Verify insurance eligibility and benefits prior to inpatient and outpatient surgery.

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List of certification specialist skills to add to your resume

The most important skills for a certification specialist resume and required skills for a certification specialist to have include:

Patients
Medical Terminology
Surgical Procedures
Medicaid
Data Entry
Certification Process
HIPAA
Insurance Benefits
CPT
Insurance Verification
NIST
Insurance Coverage
Outpatient Procedures
Patient Eligibility
Insurance Eligibility
Physical Therapy

Patient Charts
Telephone Calls
Computer System
Federal Regulations
Computer Programs
State Regulations
EMR
ICD-9
Medical Necessity
HUD
Radiology
FAA
Technical Assistance
Medical Procedures
Insurance Carriers
Hippa

Office Procedures
MRI
Patient Accounts
Diagnosis Codes
Procedure Codes
Windows
Scheduling Appointments
Durable Medical Equipment
Clinical Data
State Standards
Insurance Certificates
ISO
Medical Certification
Inspection Reports
PowerPoint

Updated January 8, 2025

Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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