Pre-Certification Specialist

Duties and Responsibilities

• Contacts insurance companies and other payors to notify of admissions
• OBTAINS AND CLARIFIES PROCEDURAL AND DIAGNOSIS INFORMATION FROM PHYSICIAN
• IDENTIFIES CORRECT INSURANCE PLAN AND CONTACTS THE PATIENT TO DETERMINE IF SECONDARY INSURANCE COVERAGE EXISTS
• RECEIVES AND PROCESSS REQUESTS FOR INTERNAL TRANSFERS FOR CONFIRMATION OF PATIENT BENEFITS AND NOTIFICATION OF PATIENT STATUS CHANGE
• VERIFIES INSURANCE COVERAGE AND BENEFITS FOR PATIENT ADMITTANCES EITHER ELECTRONICALLY OR VIA OTHER MEDIA
• MAKES WRITTEN AND/OR VERBAL INQUIRIES TO THIRD PARTY PAYERS TO VERIFY INSURANCE STATUS AND OBTAIN PRE-CERTIFICATION
• REFERS PATIENTS TO FINANCIAL COUNSELORS TO ASSIST WITH PAYMENT FOR SERVICES
• CREATES PATIENT PRE-REGISTRATION ACCOUNTS IN THE ELECTRONIC SYSTEM TO ALLOW FOR THE ADDITION OF NOTES TO AN ACCOUNT
• KEEPS ORDERLY FILES OF INFORMATION THAT IS GATHERED
• DISTRIBUTES INFORMATION TO APPROPRIATE DEPARTMENTS TO EXPEDITE PATIENT CARE
• PERFORMS VARIOUS CLERICAL TASKS TO EXPEDITE THE VERIFICATION PROCESS, INCLUDING DOCUMENTATION OF GUARANTOR INFORMATION, PATIENT INFORMATION AND PROTOCOLS
• ANALYZES REPORTS TO DETERMINE CHANGES IN PATIENT TYPES
• PERFORMS OTHER DUTIES AS ASSIGNED
• REVIEWS AND MONITORS PENDING PRE-CERTIFICATION CASES DAILY, ENSURE TIMELY FOLLOW-UP WITH PAYERS
• ASSISTS WITH COMPILING WEEKLY/MONTHLY METRICS (E.G., TURNAROUND TIMES, PENDING VOLUMES, DENIAL REASONS)

Required Knowledge, Skills, and Abilities

• High School Diploma required
• MUST HAVE 2 YEARS OF COLLEGE IN GENERAL BUSINESS FIELD OR TECHNICAL SCHOOL RELATED TO MEDICAL FIELD OR EXPERIENCE EQUIVALENT TO THE ABOVE
• MUST HAVE PREVIOUS CUSTOMER SERVICE EXPERIENCE OR EDUCATION
• ABILITY TO PROVIDE EXCELLENT CUSTOMER SERVICE AT ALL TIMES
• ABILITY TO MULTI-TASK
• UNDERSTANDS MEDICAL TERMINOLOGY
• UNDERSTANDS INSURANCE TERMINOLOGY
• UNDERSTANDS MEDICARE, MEDICAID, AND COMMERCIAL INSURANCE
• PREVIOUS EXPERIENCE WITH DATA ENTRY COMPUTER SYSTEM
• ABILITY TO ORGANIZE AND SYSTEMATIC

Benefits

• Paid Sick Time - effective 90 days after employment
• Paid Vacation Time - effective 90 days after employment
• Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month
• Short and long-term disability and basic life insurance - after 30 days of employment

Disclaimer

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of functions, tasks, duties, responsibilities and requirements of employees so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of Insight Hospital and Medical Center. Insight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs. Insight is an equal opportunity employer and values workplace diversity!