Pre-Cert Specialist

Signature Healthcare•Lexington, KY

About The Position

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions. We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report , we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry. Overview Responsible for acquiring managed care authorizations for assigned facilities following the managed care companies' requirements. Pre-Cert Specialist is responsible for obtaining the appropriate reimbursement based on the negotiated Signature Healthcare contracts and securing any appropriate reimbursement for excluded items. How you Will make a difference Meet the physical and sensory requirements stated below and be able to work in the described environment. Working closely with Signature Intake Solutions to initiate and obtain managed care authorizations promptly via process used by Signature Healthcare. If a preferred vendor is required by the health plan for ancillary needs ( x-ray, pharmacy, ambulance, DME, etc) communicate that using Signature Healthcare Process. Documents authorizations, exclusions and other key information to the team using defined processes. Works as the liaison between the insurance pre-cert department and Signature to assure appropriate process are followed. Responsible for collaborating with other members of the managed care team as required to assure successful managed care outcomes. Ensures compliance with federal and state regulations as well as the Signature HealthCARE companies policies and procedures. Cooperatively works with the Sales and Marketing team. Conducts job responsibilities in accordance with the standards set by the Code of Conduct, Policies and procedures, applicable federal and state laws, and applicable professional standards.

Requirements

Registered Nurse or Licensed Practical/Vocational Nurse with current state license, preferred.
Three (3) years' experience in a Long-Term Care environment preferred working directly with Managed Care Services.
Experience with the Case Management Process.
Effective verbal and written English communication skills.
Demonstrated advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation, and Adobe.
Highest level of professionalism with the ability to maintain confidentiality.
Customer service oriented with the ability to work well under pressure.
Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
Strong analytical and problem-solving skills.
Ability to work with minimal supervision, take initiative and make independent decisions.
Ability to deal with new tasks without the benefit of written procedures.
Approachable, flexible and adaptable to change.
Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.

Responsibilities

Working closely with Signature Intake Solutions to initiate and obtain managed care authorizations promptly via process used by Signature Healthcare.
If a preferred vendor is required by the health plan for ancillary needs ( x-ray, pharmacy, ambulance, DME, etc) communicate that using Signature Healthcare Process.
Documents authorizations, exclusions and other key information to the team using defined processes.
Works as the liaison between the insurance pre-cert department and Signature to assure appropriate process are followed.
Responsible for collaborating with other members of the managed care team as required to assure successful managed care outcomes.
Ensures compliance with federal and state regulations as well as the Signature HealthCARE companies policies and procedures.
Cooperatively works with the Sales and Marketing team.
Conducts job responsibilities in accordance with the standards set by the Code of Conduct, Policies and procedures, applicable federal and state laws, and applicable professional standards.