Precertification Specialist, Managed Care Experience Preferred

CommuniCare Health Services•Indianapolis, IN

22h•Hybrid

About The Position

The Pre-certification Specialist assists in developing census and providing external and internal support throughout the admissions process. This position will be overseeing pre certs for our Central Intake office with a team of 4 others for the entire Division in Ohio and Indiana for our skilled nursing homes. The role is full time, hourly and involves some hybrid work. This position must work flexible hours. This is not a sales position and the workplace is in an office setting - not in a nursing home.

Requirements

Previous admissions experience required
Managed Care Precertification experience preferred
Must have knowledge of Medicaid, Medicare, and Managed Care procedures, as well as laws, regulations, and guidelines that pertain to skilled nursing.
Knowledge of Corporate Business Management
Must work flexible hours
Ability to work independently and as a team
Superior customer service skills, including the ability to resolve conflict
Good organization skills
Ability to communicate effectively verbally and in writing
Must be respectful and a team player
Must maintain a professional appearance and demeanor
Must maintain a high level of confidentiality in all aspects of the job
Must be able to deal tactfully with team members, other staff, residents, and family members, visitors, government agencies, and the general public.
Must have the ability to make independent decisions when circumstances warrant such action.
Must be skilled at multitasking and have a sense of urgency to perform time sensitive processes.
Must possess basic computer skills.

Nice To Haves

Managed Care experience preferred

Responsibilities

Perform all pre-certification processes for Admission.
Establish and maintain a positive and professional relationship with current and potential Managed Care providers and work to ensure patient and provider satisfaction.
Communicate with Interdisciplinary team daily to process managed care referrals for precertification approval.
Organize and maintain documentation of clinical records for submission to managed care organizations.
Maintain up-to-date financial knowledge of skilled operations, managed care contracts and provide accurate documentation of all services in order to assure accurate reimbursement from all payor sources.
Demonstrate excellent communications, negotiation, and public relations skills.
Demonstrate autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.