Precertification Coordinator

Neurocare Inc•Memphis, TN

7d•Remote

About The Position

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.

Requirements

High school diploma or GED
Excellent organizations and communication skills.
Excellent time management skills with meticulous attention to detail.
Good team and interpersonal skills.
Ability to multi-task and handle a variety of situations at one time.
Outstanding customer service skills.
Computer skills in Word and Access; ability to be trained, understand, and use new software programs.
Strong critical thinking and problem-solving skills.

Nice To Haves

Bachelors degree preferred
Medical background and knowledge of medical terminology preferable

Responsibilities

Identifies payor coverage and makes online and/or verbal inquiries to third party payers to verify pre-certification status.
Performs various clerical tasks to expedite the precertification process, including documentation of patient information, and medical record reproduction to provide supporting medical necessity documentation.
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.
Coordinate referrals from the PCP to the specialist ordering a sleep study, when such referrals are required prior to study precertification.
Provide precertification information received from the referring physician to the payor, and monitor for decision outcome.
Communicate outcome to physician and patient.
Communicate with physicians to clarify orders or request an alternative study as approved by the payor.
Identify and communicate changes to precertification criteria, requirements, processes as required by payors.
Verify information obtained is accurately entered into patient account platforms.
Communicate regularly with customers, insurance companies and healthcare providers to ensure thorough and accurate verification of coverage.
Enter detailed notes in patient database regarding communication with customer and steps taken in verification process.
Work closely with other team members, client administrative staff and physicians and physician office staff to ensure highest level of customer service and compliance with regulatory guidelines.