Pre-Certification Representative II - Medical Group Neurology

Position Summary

The Pre-Certification Representative II is responsible to initiate and manage referrals / pre-authorization / pre-certification based on clinical orders for an assigned patient population. In addition, the Pre-Certification Representative II is responsible to determine insurance eligibility and, as appropriate, benefits and medical necessity requirements based on patient specific insurance.

What You Will Do

• Synthesizes referral and / or pre-certification requests for physician visits, diagnostic testing, procedures, Botox injections.
• Communicates and coordinates with office or physician if payer specific additional clinical information of physician peer to peer is necessary to successfully process the referral or pre-certification.
• Communicates negative payer determinations (denied authorizations) to ordering physician and Practice Manager to facilitate decision making in clinical next steps.
• Communicates third party payer decision on authorization / pre-certification to patient. This includes communication and education of patient regarding patient specific insurance carrier requirements and possible out of pocket patient responsibility.
• Documents outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals, denials, status, outcomes, etc.
• Consistently follows prescribed workflows, standards and protocols for managing and obtaining referrals, authorizations and priorities.

What You Will Need

• Education: High School Diploma
• Experience: 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation, processing and coordination strongly preferred.

Benefits

• Career Pathways to Promote Professional Growth and Development
• Variety of Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program
• Savings Plan
• Health Savings Account Options
• Retail Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities