Tier 1 Precert Specialist

CAMPBELL CLINIC PC•Cookeville, TN

14h

About The Position

Responsible for all aspects of assigned patient pre-certification of surgery. This role requires an individual to perform essential functions satisfactorily, with or without reasonable accommodation. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform these functions.

Requirements

High School Graduate or General Education Degree (GED)
Previous healthcare billing experience is required
Must be computer literate
Basic computer skills required
Must be able to type

Responsibilities

Verifies and updates insurance information and demographics
Pre-certifies all surgeries
Reviews insurance eligibility
Keeps up with changes in billing and pre-cert guidelines (Including LDC’s)
Reports denial trends to coders and manager
Reviews insurance eligibility and rejections/errors
Enters authorization information into Athena
Follows-up with aging buckets
Scans surgery scheduling sheets to Athena
Enters surgeries on the Excel spreadsheet and scheduling book for each doctor
Determines and reviews financial responsibilities and insurance coverage with patients
Reviews surgery costs and establishes payment plans for patient portion
Keeps up with changes in payor processes and reports them to coordinator for appropriate action
Obtains all pre-certifications
Responds to correspondence from payors and patients
Regular and predictable attendance
Ability to work in a cooperative manner with others
Performs other duties as assigned