Precertification Specialist | Central Scheduling, Full-Time

Memorial Health•Marysville, OH

3d•Onsite

About The Position

We are looking for a Precertification Specialist to join our collaborative team at Memorial Health! This role involves managing precertification requirements, ensuring timely submission of precertifications, and communicating with patients and provider offices regarding authorization status. The specialist will also play a key role in patient experience, providing clear instructions, resolving inquiries, and maintaining patient confidentiality. Additionally, the role requires strong interpersonal skills, teamwork, and a commitment to Memorial Health's values.

Requirements

High school diploma or equivalent
Personal computer/data entry experience preferred
Six months working in the healthcare environment preferred
Experience with Microsoft Word, Excel and Outlook preferred
Strong telephone and interpersonal communication skills
Teambuilding skills
Understanding of medical terminology and medical coding preferred
Excellent customer service skills

Nice To Haves

Personal computer/data entry experience
Six months working in the healthcare environment
Experience with Microsoft Word, Excel and Outlook
Understanding of medical terminology and medical coding

Responsibilities

Answers incoming phone calls and provides relevant information.
Gathers pertinent patient information and inputs it into the Hospital information system.
Ensures scheduling and authorization practices are consistent with internal policies and external requirements.
Obtains and/or reviews scanned Medicare, Medicaid, and third-party insurance cards.
Instructs patients on what to bring for scheduled appointments.
Notifies patients of out-of-network insurance status.
Completes medical necessity verification for Medicare outpatient tests and services.
Completes verification of patient insurance plan eligibility and benefits.
Monitors scheduling workqueues and third-party referral websites daily.
Prioritizes urgent/emergent referrals and orders.
Reviews and transcribes faxed orders and referrals into the EMR.
Distributes faxed documentation as necessary.
Provides clear instructions to patients and/or provider office regarding appointments, procedures or testing.
Sends preparation instructions for procedures to patients at the point of scheduling.
Documents all incoming and outgoing communications within the EMR.
Updates scheduling status, communication attempts and other relevant information within the EMR.
Informs Team Lead and Central Scheduling Management team of any significant delays or patient experience issues.
Reschedules appointments timely.
Places patients on waitlist as requested.
Monitors the Central Scheduling Shared Inbox daily.
Takes steps to avoid duplicate medical record creation and reports duplicate MRNs.
Communicates and coordinates scheduling with other hospital departments.
Inputs patient appointment recalls and completes recall report process monthly.
Sends reminder letters to patients for specific services.
Reviews precertification requirements at the point of scheduling.
Completes timely submission of precertifications.
Reviews Referral Authorization workqueue daily.
Requests additional clinical information from the ordering provider office if requested by the payor.
Notifies the patient and ordering provider office of any precertification delays and/or denials.
Provides insurance precertification denial information to the ordering provider office.
Scans all precertification approvals or denials to the patient’s Medical Record.
Updates or submits precertification upon request for urgent testing or in the event a test is changed on the date of service.
Reviews Central Scheduling shared inbox daily for appointments without precertification information.
Upon request, reviews denied claims due to lack of prior authorization and submits retroactive submissions if permissible.
Communicates authorization status to Team Lead or Management Team.
Demonstrates willingness and ability to go above and beyond to answer patient inquiries.
Respectful and courteous during interactions with patients, families, payors or co-workers.
Demonstrates a strong representation of Memorial Health’s values.
Displays enthusiasm while applying quick thinking and resourcefulness.
Connects patients with appropriate staff for cost estimates, financial assistance and HCAP.
Receives patient concerns and complaints and provides resolution or escalation.
Ascertains and documents in the patient’s appointment and/or demographics any specific patient needs.
Makes reasonable attempts to schedule patients for appointments and testing based on patient preference.
Maintains confidentiality at all times to protect patient privacy and adheres to HIPAA privacy and security regulations.
Acts as a resource for new employees and precepts as needed.
Communicates dissatisfaction with issues to Coordinator/Manager and contributes to solutions.
Cooperates with co-workers to resolve conflict.