Clerk - Precert Referral

Kindred Healthcare•Hartsville, SC

1d•Onsite

About The Position

Carolina Pines Regional Medical Center, a 116-bed community hospital in Hartsville, SC, is seeking a Pre-Cert and Referrals Clerk. This role is responsible for obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all commercial payers. The hospital has received numerous awards and recognitions for its commitment to excellence, safety, and community care.

Requirements

Requires critical thinking skills, decisive judgement, and the ability to work with minimal supervision.
Must be able to work in a stressful environment and take appropriate action.
High School Diploma or Equivalent.
2 years of experience in a medical related field required.

Nice To Haves

Postsecondary (Cert/Diploma/Program Grad) vocational or specialized training.
2 years medical prior authorization/referrals experience preferred.

Responsibilities

Schedules outpatient diagnostic tests and referrals as ordered by the providers and documents them in Athena.
Maintains knowledge of insurance carrier requirements and organizes necessary information to obtain authorizations or precertifications.
Works with referring providers to resolve insurance denials or requests for additional information.
Notifies patients of their scheduled appointments and documents their acknowledgement.
Performs other general administrative tasks as directed by the team lead.
Verifies order completeness and accuracy using electronic and paper pre-certification data.
Contacts insurance carriers to downgrade or upgrade pre-certs.
Reviews claim denials and appeals them as justified.
Verifies the completeness and accuracy of coding using resources such as CPT and ICD-9 provider manuals, Medicare’s Correct Coding Initiative, subscriptions, and publications.
Contacts insurance carriers to verify claim status and resolve processing problems.
Identifies problem payers and reports them to the Assistant Practice Administrator.
Documents all insurance follow-up activity.
Participates in educational activities.
Maintains strictest confidentiality.
Looks for trends of denials and reasons for those denials to minimize lost revenue.
Maintains and updates a list of insurance carriers and companies.
Monitors changes in the insurance industry and notifies office staff of those changes and policies.
Performs related work as required.
Other duties as assigned.