Pre-Certification Specialist (33038)

Position Summary:

Works with surgery scheduling, front office staff, radiology scheduling and billing to ensure that insurance referrals are in place and correct with appropriate visits available. Contacts insurance carriers for pre-authorizations of procedure and medications and ensures that required approvals are obtained prior to patient visit. Responsible for accurate data entry of patient demographics and documentation of all pre-authorizations. Responsible for calculating estimated patient responsibility for procedures and medication. Ensures that all details of the visit are communicated to the patient including estimated cost when appropriate so that upon arrival the appointment can go as scheduled. You are second in command to the manager and will serve as the point of contact should the manager be unavailable or out of the office.

Qualifications:

• High school degree or GED required
• Computer skills required.
• Strong organization skills.
• Strong communications skills, both oral and written.
• Insurance authorizations experience preferred
• Some medical terminology knowledge

Contacts:

Interacts with all levels of the URA and Anova business organization, insurance carriers and patients

Job Responsibilities:

• Have excellent understanding of all protocols regarding referrals and pre-authorizations as designated by the departments. Exceptional attention to detail
• Knowledge. Understanding of all appointment types
• Pulls reports daily to ensure that patient referrals and authorizations are completed prior to patient arrival.
• Maintain standard 2 weeks ahead of appointment date for all pre-auths and referrals
• Maintain/recheck documentation and scan completed authorizations and pre-auths in EMR.
• Enters authorizations information, including estimated cost and authorization status, into notes in the patient management system and EMR.
• Reply to all inter-office email requesting authorizations and referrals
• Communication with office and nursing staff upon completion of urgent/ stat referral/preauths.
• Request referrals from PCP's for new and establish patients and link to appts
• Obtain pre auth's per the standard work list
• Contact patient with estimated cost prior to appointment and document in PM.
• Follow up on any outstanding pre-auths and referrals
• If claim denies for no authorization or referral you will be required to get a retro or appeal with insurance
• Ensure that HIPAA regulations are followed at all times.
• Enter all demographic and insurance information accurately and completely.
• You are a team and must work cooperatively with your co-workers.
• Under the supervision of the manager, work with coworkers to ensure daily completion of responsibilities, assigning tasks as needed.
• Assist manager with additional tasks as delegated.

Physical Requirements

• Manual Dexterity

Required to perform gross body coordination such as walking, stooping, and standing while performing tasks, carrying and lifting objects. Required to perform simple motor skills and manipulative skills such as typing and writing.

• Mobility

Required to sit for long periods of time.

Required to walk and stand (including for long periods of time).

• Visual Discrimination

Required to read computer screen.

• Hearing

Required to hear normal sounds with some background noise when answering phones.

• Mental Requirements:

Able to process great amounts of information, apply problem solving skills and exercise good judgment. Ability to multi-task.