Company:

MedStar Health Location:

White Marsh, MD Career Level:

Associate Industries:

Not specified Description About the Job MedStar Health is seeking an experienced Patient Access Preauthorization/Precertification Specialist I to join our team. The ideal candidate will have at least one to two years of experience in patient accounting, patient access or pre-arrival services functions. This position is predominantly remote, with intermittent on‑site obligations based on operational requirements; MedStar Health office space is available for on‑site work, if needed, at locations throughout the DC, Maryland, and Virginia area. In this role you will provide assistance to patients and providers by confirming and completing required pre-certification/authorizations prior to service to ensure a positive patient/provider experience and mitigate denials. MedStar Health is a great place to work and grow your career. We provide a supportive and inclusive work environment, comprehensive health and wellness benefits, generous paid time off, tuition assistance, retirement plans, and many other benefits focused on your wellbeing.

Primary Duties and Responsibilities Pre-Authorizations/Pre-Certification:

Verifies eligibility and conformance to the department and departmental managed care requirements and contracts. References the MedStar Managed Care Matrix and online Handbook as necessary. Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers as appropriate; Assists with pre-authorizations of scheduled procedures including hospital admissions procedures medications and medical equipment as required. Reviews all scheduled procedures and initiates authorization and pre-certification activities. Reviews all provider schedules confirms correct insurance information is available. Cross-references as needed to any application where documentation is stored to ensure completeness of work. Maintains ongoing communication with insurance companies to determine eligibility of benefits deductible status and to obtain precertification for assigned scheduled procedures. Responds to provider/hospital staff and/or patient inquiries regarding authorizations and scheduling in an efficient manner.

Pre-Authorization/Pre-Certification:

Ensures all relevant data is entered into the IDX application links data to the appropriate appointment/visit and enters the required data elements to ensure that accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters into the appropriate field in the Appointment Data Form (ADF) or other required fields as necessary. Communicates if the appointment needs to be rescheduled due to a missing Referral or Authorization number.

Pre-Authorization/Pre-Certification:

Confirms all relevant data is entered into SMS/Invision authorization fields to ensure accurate billing information is submitted to the appropriate insurance carrier. Obtains any missing pre-certification or authorization numbers and enters into the appropriate fields. Monitors and completes the MedConnect Pre-Authorization Work Queue as required with accurate authorization status and communicates with designated provider staff regarding any information required to complete the authorization requirements. This includes but is not limited to additional documentation Peer-to-Peer requests etc. Maintains current knowledge of regulatory and specific changes as it relates to Pre-Authorization and Pre-Certification requirements. Minimal Qualifications Education High School Diploma or GED required Experience 1-2 years' experience in patient accounting, patient access or pre-arrival services functions required An equivalent combination of experience and college education in accounting, finance or healthcare administration. Knowledge Skills and Abilities Working knowledge and demonstrated proficiency in payer authorization and clearance processes. Requires basic working knowledge of

UB04, HCFA

1500 or equivalent and payer responses. Requires some knowledge of medical terminology and

CPT/ICD-10

coding. Excellent communication, analytical, interpersonal and organizational skills. Proficient uses of hospital registration and/or billing systems and personal computers as well as Microsoft Excel and Word applications. Ability to type 35 WPM. 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