Remote Precertification Coordinator

NeuroCare-posted 10 days ago
Full-time • Entry Level
Remote • Memphis, TN
51-100 employees
Ambulatory Health Care Services
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This position is fully remote but candidate must reside in: GA, IL, TN, AZ, NH, MA, CT, FL, or TX. Why Neurocare? Great introduction to Healthcare Administration Promotes from within (many of our coordinators have been promoted to other positions within the company) Dynamic, professional environment Excellent training Independent work within a team environment Learn about the exciting field of sleep medicine Neurocare, Inc., is the largest employer of Sleep Technologists in the New England area for over 25 years. We are a patient-centric, quality-focused organization. We collaborate with high profile academic medical centers, community hospitals, and physician groups to design and manage state of the art sleep disorder programs. Our strong commitment to uncompromising quality care and customer service has driven our reputation as a leader in the field. The Precertification Coordinator works as part of a team with responsibility for providing customer service to a wide range of internal and external customers within a busy clinical setting. Under general direction, coordinates all precertification aspects for sleep study referrals including facilitation of precertification information with the referring physician, educating the patient to the precertification process, working with the patient and physician to identify alternatives when a precertification is denied.

  • Identifies payor coverage and makes online and/or verbal inquiries to third party payers to verify pre-certification status.
  • Analyze physician medical record documentation and work with physicians to ensure optimal documentation of medical necessity and to qualify the patient for the optimal testing type given the patients' needs, abilities, and functional status, comorbidities, and signs and symptoms of sleep disorders-within the payor guidelines.
  • Effectively utilize online and system resources to obtain missing information.
  • Submit precertification information received from the referring provider to the payor through online portal, phone, or fax, and monitor for decision outcome. Communicate outcome to physician and patient and accurately document in EMR.
  • Communicate with physicians to clarify orders or request an alternative study as approved by the payor, including appeal options or alternative testing.
  • Identify and communicate changes to precertification criteria, requirements, processes as required by payors.
  • Work closely with other team members, client administrative staff, physicians, and physician office staff to ensure highest level of customer service and compliance with regulatory guidelines.
  • Maintain current working knowledge of regulatory requirements, insurance guidelines and sleep testing criteria, communicating changes, trends, findings and outcomes as necessary to team members, managers, clients, and patients.
  • High school diploma
  • Bachelors degree preferred
  • 2+ years relatable customer service/healthcare experience
  • Medical background and knowledge of medical terminology preferable
  • Excellent organizational skills with meticulous attention to detail
  • Strong analytic abilities, critical thinking and problem solving skills
  • Ability to multi task, handle a variety of situations
  • Outstanding customer service and interpersonal skills
  • Good team and interpersonal skills
  • Ability to work independently
  • Proficient with Microsoft Word and Excel; ability to adapt to new software
  • Strong written and verbal communication skills
  • Bachelors degree
  • Medical background and knowledge of medical terminology
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