Precertification Specialist Thursday - Monday

Under the supervision of the Utilization Review Manager, this position is responsible for ensuring the delivery of outstanding customer service in the process of obtaining pre-certification approvals from insurance companies (for both inpatients and outpatients), identifying insurance and/or patient responsibility, insurance verification, admission notifications, identifying approved days, follow up required, and providing financial counseling when appropriate.

Responsibilities

Ensuring all scheduled and non-scheduled inpatient and outpatient accounts are pre-authorized either in advance or on the day of the notification of admission; Providing and interpreting clinical information submitted from the Physician to complete the pre-certification process; Working with Physician offices, Case Management, Utilization Review, and patients to obtain supporting clinical data for the payer; Obtaining complete and accurate insurance information and completing verification of patient eligibility for inpatient and outpatient visits; Acting as liaison and point of contact between clinical staff, ancillary departments, patients, referring Physician's office, and insurance payers to inform of authorization delays/denials; Collaborating with Utilization Review nurses to ensure authorization is obtained and documented in the patient account; Ensuring thorough documentation of verification and authorization activities; Communicating with Physician offices and payers to initiate and mediate Physician to Physician reviews; Understanding payer requirements in relation to procedure vs. plan type and determining when pre-authorization is needed; Accurately and timely documenting pre-certification in the appropriate account; Collaborating with the appeals department to overturn denied claims; Monitoring insurance authorization issues to identify trends and participating in process improvement initiatives; Answering, managing, and satisfying customers during all incoming calls and meeting department goals and NGHS STARS customer service standards; Performing related job duties as assigned

Requirements

High School Diploma or GED; Ability to work independently, emotionally mature, and able to function effectively under stress; Excellent problem solving and analytical skills; Excellent written and oral communication skills; Ability to prioritize, organize, and coordinate daily work load; Working knowledge of Protected Health Information; Ability to manage change; Extensive knowledge of medical terminology; Must possess detailed understanding and knowledge of insurance guideline and protocols, the components of full verification, and payer information / requirements

Nice to have

AAPC, AHIMA or CPC certification strongly preferred; 3–5 years of relevant experience in insurance authorization, precertification, medical billing, revenue cycle, patient access, or related healthcare operations strongly preferred