Precertification Specialist

CENTERS FOR PAIN CONTROL•Valparaiso, IN

4d•Onsite

About The Position

The Precertification Specialist is responsible for the completion of precertification, prior authorization and notification for third party and government payers for all scheduled outpatient procedures and diagnostic testing. The Precertification Specialist is responsible for communicating with insurance companies, clinic staff, outside physician offices, facilities and patients to ensure authorizations are obtained in a timely manner.

Requirements

Knowledge of Electronic Medical Record
Good typing skills
Good internet navigation skills
Knowledge of instrumentation used in office (fax, credit card, copy)
Knowledge of multi-line phone system
Knowledge of medical terminology with a strong focus on the vascular, spine and skeletal system
Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing, with demonstrated ability to interpret such guidelines
advanced knowledge and skill in CPT, ICD-10-CM and HCPCS code assignment.
Strong communication and organizational skills
Previous hospital/ambulatory surgery center, or physician billing experience preferred
Minimum of 2 years experience working with health insurance verification, insurance authorizations, or specialist referrals
Knowledge of common safety hazards and precautions to establish a safe work environment
Must be able to act calmly and effectively in busy, stressful or emergency situations
Ability to communicate effectively in person, by phone and in writing
Requires adherence to all policies and procedures, including standards for safety, attendance, punctuality and personal appearance
HEARING: Adequate to perform job duties in person and over the telephone.
SPEAKING: Must be able to communicate clearly to patients & staff in person and over the telephone.
VISION: Requires eyesight correctable to 20/20 to operate equipment and read information from printed sources and computer screens.
Requires frequent lifting and carrying items weighing up to 50 pounds unassisted, including assisting patients when required.
Adequate physical ability to be present where needed.
Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting and sitting, with some heavy lifting, pushing and pulling exerted regularly throughout a regular work shift.
Requires exposure to communicable diseases, bodily fluids, medicinal preparations and other conditions common to a clinic environment.

Nice To Haves

Previous hospital/ambulatory surgery center, or physician billing experience preferred

Responsibilities

Prioritize and process incoming authorization requests/orders
Review clinical documentation to extract pertinent information which supports medical necessity
Obtain patient benefit and eligibility status for pending procedures
Communicate effectively with payers and third party utilization management companies to achieve positive outcomes
Identify payer trends and provides feedback to the Billing Team Supervisor and providers
Appeal denied authorizations when warranted
Initiate peer to peer reviews and prepares documentation packets for the provider
Maintain understanding of payer medical policies and guidelines
Manage work queues, emails and phone messages timely and effectively
Develop and maintain personal and professional skills
Attend all mandatory staff meetings per year unless excused as evidenced by documentation
Attend mandatory in-services and a minimum of two pertinent in-services per year as documented
Actively participate in performance improvement activities as observed or documented
Establish realistic professional goals as evidenced by the annual performance evaluation
Actively keep abreast of departmental and organizational activities
Demonstrate flexibility in response to unexpected change in workload or situations as observed
Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle
Assist in the orientation of new personnel as directed
Support the mission and goals of the company as observed
Address all emails within 24 hours as documented
Perform other duties as required
Demonstrate safe and cost-effective practice
Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed
Consistently utilize proper body mechanics as observed
Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart
Consistently allocate resources to reduce waste and minimize costs as observed
Consistently complete assigned duties within stated shifts in a timely manner as observed and documented
Strive for excellence
Set challenging goals
Produce quality work in a timely fashion
Maintain current knowledge and skill
Participate in quality and process improvement efforts
Keep the work area clean, safe and secure
Act Flexibly
Adapt to change
See the value of different opinions and new ideas
Change plans and objectives given new direction or priorities
Handle stressful situations effectively
Meet Customer Needs
Meet internal and external customers’ needs
Find new ways of satisfying customers
Participate in service improvements efforts
Listen and respond to customers
Treat customers with compassion and respect
Work as a Team
Work as a team player
Pitch in to help those in need
Communicate with others appropriately
Listen and respond to others
Handle conflict situations effectively
Foster trust and respect within the team
Participate in committees and task forces
Foster Diversity in the Workforce
Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability
Treat all associates and customers fairly
Be Self-directed
Take initiative and responsibility for actions
Identify own learning needs and create/implement Learning Plans
Perform duties according to policies and procedures
Demonstrate ethical behaviors
Maintain confidentiality of information
Maintain licenses and certifications as appropriate
Fulfill operating unit/clinical competencies
Use equipment/resources responsibly
Refer to upper management for approval or final disposition on the following: Change in procedure, Difficult patient situations, Any situation you are unsure of
Must be willing to do any additional assignment by management