Pre-Certification Specialist -- CAMC Pediatric Neurology -- WCH-MSOB
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About The Position
The Pre-Certification Specialist at CAMC Pediatric Neurology is responsible for ensuring the procurement of accurate pre-certification authorization and referrals for both returning and new patients. This role involves a thorough review and completion of patient charts to ensure all necessary information is accurately documented. The specialist will be tasked with scheduling multiple physician-ordered tests, exams, and surgeries as required. Daily responsibilities include reviewing patient charts to determine the need for pre-certification or referrals, as well as assessing specific patient insurance information to ascertain medical necessity requirements for various treatments. The specialist will correspond with Medicare and various insurance companies to facilitate the acquisition of pertinent data related to compliance, authorizations, verifications, progress notes, and medical necessity guidelines. In addition to these duties, the Pre-Certification Specialist will perform clerical tasks such as composing letters to patients, insurance carriers, and referring physicians regarding any issues that may arise. They will also schedule patient surgeries as per physician orders and communicate all necessary information to the relevant parties. Establishing new patient accounts in billing software upon receiving referrals from physicians is another critical aspect of this role, along with maintaining continuing education on treatment trends, current medical terminology, and coding systems such as ICD-10, CPT, and HCPCS. The specialist will also cross-train for front desk and medical assistant roles, providing backup support as needed, and will be responsible for scheduling all procedures and managing financial transactions related to patient care.
