PRE-CERTIFICATION SPECIALIST

Premier Health • Moraine, OH

15h • Onsite

About The Position

The Pre-Certification Specialist is responsible for the completion of pre-certification, prior authorization and notification for third party and government payers for all pre-scheduled elective inpatient/outpatient procedures and diagnostic testing. He/she is responsible for communicating with insurance companies and/or physician’s offices to ensure the pre-certifications are obtained. He/she must maintain compliance with regulatory requirements.
The Pre-Certification Specialist must demonstrate Customer Focus (15) and expert Functional/Technical Skills (24) while providing pre-certification evaluation of each scheduled inpatient or outpatient patient case. The Pre-Certification Specialist must comprehend the clinical aspect of the chart and how to apply it to ensure authorization of the accounts. The Pre-Certification Specialist is required to maintain excellent customer service standards at all times in order to effectively communicate with physicians, physician offices, insurance representatives, patients, and co-workers. Pre-Certification Specialists are required to efficiently perform all duties while ensuring patient confidentiality and privacy rights.

Requirements

• High school diploma or GED required.
• Two years of Patient Access, Health Information Management, Physician Office, Billing, Collections or Compliance experience required.
• Applicable class work may be substituted for previous work experience.
• Demonstrate knowledge of medical terminology and basic anatomy/physiology.
• Equivalent combination of education and experience will be considered.
• Ability to perform a variety of tasks, often changing assignments on short notice.
• Must be adept at multi-tasking, organizing, priority, and time management.
• Will be required to learn and work with multiple software/hardware products to be used during the course of an average work day.
• Must possess excellent communication skills, both verbal and written.
• Most possess excellent telephone skills.
• Must be able to maintain a professional demeanor in stressful situations.
• Must be adept with machinery typically found in a business office environment.
• Able to build productive relationships with all contacts.
• Must have analytical skills to resolve simple to semi-complex problems.
• Must be proficient in Windows-based computer technology, including keyboarding and typing at least 35 wpm.
• Employee is regularly required to sit, stand, walk, talk and hear.
• Must possess visual acuity and manual dexterity to perform computer data entry and other clerical aspects to the job.
• May bend, stoop, twist and reach in conjunction with the job requirements.
• May lift files, reference books, supplies and other documents up to 10 lbs.
• May walk and push a wheeled cart with a computer and supplies weighing up to 50 lbs.
• This is both a sedentary and active position.
• Must be able to prioritize tasks and determine appropriate sequence for task completion.
• Must be able to respond to patients’, physicians’ and other customers’ questions, concerns and comments in a professional manner.
• Is regularly exposed to noise associated with working around others in an office setting.

Nice To Haves

• Associate Degree in related healthcare or business field preferred.
• Medical Terminology Certification preferred.
• Two Years of previous insurance experience and/or pre-certification experience preferred.

Responsibilities

• Completion of pre-certification, prior authorization and notification for third party and government payers for all pre-scheduled elective inpatient/outpatient procedures and diagnostic testing.
• Communicating with insurance companies and/or physician’s offices to ensure the pre-certifications are obtained.
• Maintaining compliance with regulatory requirements.
• Providing pre-certification evaluation of each scheduled inpatient or outpatient patient case.
• Comprehending the clinical aspect of the chart and how to apply it to ensure authorization of the accounts.
• Maintaining excellent customer service standards at all times in order to effectively communicate with physicians, physician offices, insurance representatives, patients, and co-workers.
• Efficiently performing all duties while ensuring patient confidentiality and privacy rights.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED