Pre Certification Specialist - Patient Access

Pre Certification Specialist -

Patient Access SUMMARY:

Under the direction of the Patient Access/Central Scheduling Manager, the Pre-Cert Specialist is responsible and accountable for the daily oversight of all Insurance and Eligibility verification for In-Patient admissions and Surgical procedures as scheduled and/or add on procedures throughout the various hospital departments. Responsible for contacting provider(s) offices regarding the necessity of prior authorizations to ensure appropriate reimbursement for surgical procedures. Responsible for obtaining authorization for all required In-patient hospitalizations. Responsible for the identification of any In-Patient admissions that may require retro-authorization in order to obtain reimbursement. Responsible for contacting the appropriate provider(s) as necessary when Insurance and Eligibility changes in coverage are identified. Utilizes a variety of communication methods to effectively communicate inter-departmentally, with provider(s) offices as well as with Insurance companies. Functions as subject matter expert to both internal and external customers.

JOB REQUIREMENTS

Education:

High school diploma or equivalent

Experience:

12 to 18 months related experience and/or training in the healthcare and/or office/clerical and customer service fields. Prior work experience with Medicare, Medicaid and Private Insurance carriers is preferred.

Other:

Preferred applicant will have a working knowledge of medical terminology, ICD 10, CPT and HCPCS coding basics. Adaptability to multiple systems is essential.

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 with or without an accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to perform the following: Must have the ability to communicate effectively, orally and in writing, to solve problems and make decisions. Spend 8 hours or more in front of computer, monitor or similar screen utilizing keyboard and/or mouse, daily. Ability to stand and walk, bend, squat, and twist, and occasionally lift 20 pounds with proper body mechanics. Acuity to the five senses is required. Must be able to handle critical and highly stressful situations with efficiency and composure.

Work Environment :

Office setting, within a hospital environment