Precertification Specialist

Saint Luke's Health System•Kansas City, MO

1d•Onsite

About The Position

The Precertification Specialist obtains prior authorizations and precertifications required by third-party payers for procedures, testing, and surgeries performed in the department or elsewhere. The role collaborates with clinicians, technicians, department staff, payer representatives, and other teams to gather and submit necessary information. The specialist also communicates with patients about their benefits and expected out-of-pocket costs. The position is onsite at the Plaza location, with occasional travel to other ENT locations as needed. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with no nights or weekends.

Requirements

At least 2 years of applicable experience.

Responsibilities

Obtain precertifications and prior authorizations for in-clinic procedures, testing, surgeries, injections, and other services, as required by insurance, before scheduled dates for both facility and physician billing.
Assist with Hearing Aid Services.
Provide front-office support.
Coordinate with physicians to ensure the patient’s condition meets insurance eligibility criteria.
Update appropriate work queues in Epic, including notes on calls, contacts, prior authorization numbers, and authorization periods.
Coordinate with the Financial Clearance Center Team to gather information needed to communicate benefits and patient responsibility for facility billing.
Run reports in Experian to obtain physician billing estimates and coordinate with the Physician CBO to gather information needed to communicate benefits and patient responsibility for physician billing.
Regularly update patients about prior authorizations and provide estimates of their responsibility for facility and physician billing.
Coordinate with OR and/or ASC staff to obtain scheduling information and arrange communication with patients.
Schedule procedures with vendor representatives as needed.