Pre-Certification Specialist II
About The Position
This position provides financial quality support in ensuring services requiring prior authorization/pre-certification are verified and approved prior to service or within allowed timeframes. This position is essential for denial prevention to confirm payor guidelines are followed for front-end revenue cycle tasks. Position also responsible for transparent and comprehensive communication and documentation of outcomes of prior authorizations. This role works in conjunction with other professionals on the financial clearance team, preparing a patient's account for check-in and/or securing prior authorizations for admissions. At Children’s Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity. Additionally, it’s important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children’s Mercy staff, we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you are selected for this position, you will be asked to supply your immunization records as proof of vaccination. If you and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.
Requirements
- Associate's Degree or equivalent hours and 1-2 years experience 2 years experience (individually or combined) in previous customer service setting, business office setting, and/or call center or HS diploma or equivalent and 2-3 years (individually or combined) experience in patient access department role may be accepted in lieu of an Associate's degree, pre-certification role, or customer service position
Nice To Haves
- CHAA Certified Healthcare Access Associate preferred
Responsibilities
- Processes insurance authorization for scheduled services and/or hospital admissions requiring prior authorization as outlined in departmental policies, procedures, and workflow guidelines.
- Follows up on pending authorizations in a timely manner to identify final outcomes
- Participates in process improvement efforts, special projects, and attends meetings/committees as assigned
Benefits
- The benefits plans at Children’s Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families. Learn more about Children’s Mercy benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
