Sr. Precertification Rep

Temple University Health System • Philadelphia, PA

14h

About The Position

This position is responsible for obtaining and managing ongoing precertification/authorization for complex oncological hospital services. Responsible to coordinate peer to peer review and appeals of denials due to no authorization. Responsible to confirm the financial/insurance information obtained during the registration process to determine that State, Federal and Third Party precertification/billing requirements are met to ensure optimal reimbursement for services to be rendered.

Requirements

• Associate's Degree in related field Required
• Non Degree Program Graduate of an accredited LPN program Preferred or
• Combination of relevant education and experience may be considered in lieu of degree Required
• 3 years experience in a pre-certification/utilization role Required
• 3 years experience in precertification processes for oncological or other specialized medical services such as chemotherapy, radiation oncology, rehabilitation, dialysis, or organ transplant Required

Nice To Haves

• PA Practical Nurse License Preferred
• Cert Prof Utilization Review Preferred

Responsibilities

• obtaining and managing ongoing precertification/authorization for complex oncological hospital services
• coordinate peer to peer review and appeals of denials due to no authorization
• confirm the financial/insurance information obtained during the registration process to determine that State, Federal and Third Party precertification/billing requirements are met to ensure optimal reimbursement for services to be rendered

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree