Precertification Specialist, Managed Care Experience Preferred

CommuniCare Health Services

5d • Onsite

About The Position

The Pre-certification Specialist assists in developing census and providing external and internal support throughout the admissions process. Previous experience required; Managed Care experience preferred. This position must work flexible hours. This is not a sales position and the workplace is in an office setting - not in a nursing home. The Pre-certification Specialist is a full time, salaried position in a fun, team environment! At CommuniCare, you will enjoy competitive wages, commensurate with experience, and PTO plans. We offer you a menu of benefit options from life and disability plans to medical, dental and vision coverage, from quality benefit carriers. We also offer 401(k) with employer match and Flexible Spending Accounts. A family-owned company, we have grown to become one of the nation’s largest providers of post-acute care, which includes skilled nursing rehabilitation centers, long-term care centers, assisted living communities, independent rehabilitation centers, and long-term acute care hospitals (LTACH). Since 1984, we have provided superior, comprehensive management services for the development and management of adult living communities. We have a single job description at CommuniCare, to reach out with our hearts and touch the hearts of others. Through this effort we create Caring Communities where staff, residents, clients, and family members care for and about one another. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.

Requirements

• Previous admissions experience required; Managed Care Precertification experience preferred.
• Must have knowledge of Medicaid, Medicare, and Managed Care procedures, as well as laws, regulations, and guidelines that pertain to skilled nursing.
• Knowledge of Corporate Business Management
• This position must work flexible hours
• Ability to work independently and as a team
• Superior customer service skills, including the ability to resolve conflict
• Good organization skills
• Ability to communicate effectively verbally and in writing
• Must be respectful and a team player
• Must maintain a professional appearance and demeanor
• Must maintain a high level of confidentiality in all aspects of the job
• Must be able to deal tactfully with team members, other staff, residents, and family members, visitors, government agencies, and the general public.
• Must have the ability to make independent decisions when circumstances warrant such action.
• Must be skilled at multitasking and have a sense of urgency to perform time sensitive processes.
• Must possess basic computer skills.

Nice To Haves

• Managed Care Precertification experience preferred.

Responsibilities

• Perform all pre-certification processes for Admission.
• Establish and maintain a positive and professional relationship with current and potential Managed Care providers and work to ensure patient and provider satisfaction.
• Communicate with Interdisciplinary team daily to process managed care referrals for precertification approval.
• Organize and maintain documentation of clinical records for submission to managed care organizations.
• Maintain up-to-date financial knowledge of skilled operations, managed care contracts and provide accurate documentation of all services in order to assure accurate reimbursement from all payor sources.
• Demonstrate excellent communications, negotiation, and public relations skills.
• Demonstrate autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.

Benefits

• competitive wages, commensurate with experience, and PTO plans
• life and disability plans to medical, dental and vision coverage, from quality benefit carriers
• 401(k) with employer match
• Flexible Spending Accounts

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed