Precertification Coordinator

Neurocare Inc • Memphis, TN

22h • 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.

Neurocare, Inc., is the largest employer of Sleep Technologists in the New England area for over 35 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.

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 reproduction of medical records to provide supporting medical necessity documentation.
• Works 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.
• Coordinates referrals from the PCP to the specialist ordering a sleep study, when such referrals are required prior to study precertification.
• Provides precertification information received from the referring physician to the payor, and monitors for decision outcome.
• Communicates outcome to physician and patient.
• Communicates with physicians to clarify orders or request an alternative study as approved by the payor.
• Identifies and communicates changes to precertification criteria, requirements, processes as required by payors.
• Verifies information obtained is accurately entered into patient account platforms.
• Communicates regularly with customers, insurance companies and healthcare providers to ensure thorough and accurate verification of coverage.
• Enters detailed notes in patient database regarding communication with customer and steps taken in verification process.
• Works 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.

Benefits

• 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

What This Job Offers

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