Pre Certification Clerk

Cheyenne Regional Medical Center•Cheyenne, WY

About The Position

Day in the life of a Pre-Certification Clerk: The Pre-Certification Clerk is responsible for obtaining all prior authorizations and referrals as required per insurance guidelines. This position is responsible for communication with patients, appropriate clinical departments, and/or insurance providers regarding insurance approval/denial. The Pre-Certification Clerk will also coordinate Peer-to-Peer reviews and communicate with Physicians, offices, and departments all necessary information needed to complete the authorization for services. Acts as an authority on admission criteria and insurance expectations. This position is required to work closely with clinical and billing departments, utilizing their knowledge of both areas. Why work at Cheyenne Regional? 403(b) with 4% employer match ANCC Magnet Hospital 21 PTO days per year (increases with tenure) Education Assistance Program Employee Sponsored Wellness Program Employee Assistance Program Loan Forgiveness Eligible Here is what you will be doing: Reviews all prescheduled diagnostic procedures, outpatient therapies, infusions, and surgeries daily. Reviews all diagnostic and surgery registrations for accuracy; identify and reconcile all errors. Verifies all diagnostic, procedural and surgical eligibility, and admissions, including eligibility & benefits on all worker’s compensation, and high-risk outpatients (e.g., motor vehicle or third-party liability). Obtains and document precertification, certification, and/or proper referral during the verification process to include ABN’s and financial letters. Completes all necessary forms and paperwork prior to patients being seen for services. Creates, if necessary, any pre-scheduled registrations that have not been completed prior to date of service, and route them to appropriate location. Re-checks all inpatients for accuracy. Runs estimates, prior to visit and notify patient of financial responsibility. Collects appropriate monies due or direct patient to pre-arrange for payment plans with each patient. Reviews and discusses all patient financial responsibility at the appropriate time in the admission process. Contacts MD office when authorization/referrals are pending to evaluate how to proceed as needed; contacts patient after resolution with MD office. Double checks social data for any errors, patient data, guarantor data, and reconcile if necessary, to avoid problems on bill, communicate changes to appropriate departments. Processes and evaluates physician orders for accurate patient information, physician signature, appropriate diagnosis, and procedure codes. Utilizes appropriate coding guideline to accurately assign CPT, ICD 9, ICD 10 and HCPCS codes to outpatient procedures. Maintains a high level of customer service/satisfaction; this is accomplished by timely and accurate completion of all duties as outlined above and meeting pre-defined metrics.

Requirements

Excellent verbal, written and interpersonal communication skills
Strong knowledge of the admission process
Knowledge of both government and a non-government payer
Ability to demonstrate a basic understanding of hospital insurance contracts to determine if treatment and services are covered by insurance at facility
Ability to demonstrate an independent work initiative with sound judgment and attention to detail
Ability to handle multiple tasks simultaneously
Ability to operate standard office equipment
Knowledge of medical terminology
High school diploma (or Equivalent Certificate from an accredited program) or higher degree
Two (2) or more years of healthcare registration, billing, or clinical experience

Responsibilities

Reviews all prescheduled diagnostic procedures, outpatient therapies, infusions, and surgeries daily.
Reviews all diagnostic and surgery registrations for accuracy; identify and reconcile all errors.
Verifies all diagnostic, procedural and surgical eligibility, and admissions, including eligibility & benefits on all worker’s compensation, and high-risk outpatients (e.g., motor vehicle or third-party liability).
Obtains and document precertification, certification, and/or proper referral during the verification process to include ABN’s and financial letters.
Completes all necessary forms and paperwork prior to patients being seen for services.
Creates, if necessary, any pre-scheduled registrations that have not been completed prior to date of service, and route them to appropriate location.
Re-checks all inpatients for accuracy.
Runs estimates, prior to visit and notify patient of financial responsibility.
Collects appropriate monies due or direct patient to pre-arrange for payment plans with each patient.
Reviews and discusses all patient financial responsibility at the appropriate time in the admission process.
Contacts MD office when authorization/referrals are pending to evaluate how to proceed as needed; contacts patient after resolution with MD office.
Double checks social data for any errors, patient data, guarantor data, and reconcile if necessary, to avoid problems on bill, communicate changes to appropriate departments.
Processes and evaluates physician orders for accurate patient information, physician signature, appropriate diagnosis, and procedure codes.
Utilizes appropriate coding guideline to accurately assign CPT, ICD 9, ICD 10 and HCPCS codes to outpatient procedures.
Maintains a high level of customer service/satisfaction; this is accomplished by timely and accurate completion of all duties as outlined above and meeting pre-defined metrics.