Pre-Certification Specialist

Southwoods Health•Boardman, OH

2d•Onsite

About The Position

Pre-Certification Specialist – Southwoods Executive Centre Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians.

Requirements

Training or courses in business office activities, computer skills, and medical terminology
Effective communication skills, ability to problem solve, and great attention to detail
Insurance Verification experience
Minimum of 2 years’ experience pre-authorizing medical procedure and imaging exams across modality and specialty (FP or IM office experience a plus)

Responsibilities

Respond promptly to referral source requests for information, supporting documentation, or other report needs
Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
Obtain authorization from payer sources to begin services.
Assist in resolving insurance issues, re-authorization, and eligibility issues
Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements
Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed
Facilitate follow-up regarding ongoing services, eligibility, and authorization
Communicate payer verification or benefit issues
Record insurance information to maintain data and communicate insurance information to pertinent staff
Maintain confidentiality of patient information
Independently maintain and work from the electronic medical record and additional databases
Obtain pre-certification number from physician’s office if applicable
Assist in the development, organization, and maintenance of role specific documents, policies, and tools
Follow all federal, state, and regulatory guidelines to maintain compliance
Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies
Perform other duties as assigned