PRE-CERTIFICATION SPECIALIST

About the role

Located at 3170 Kettering Blvd, Moraine, OH 45439 in the Pre-Certification department, the Pre-Certification Specialist handles pre‑certification, prior authorization and notification for third‑party and government payers for all pre‑scheduled elective inpatient/outpatient procedures and diagnostic testing.

Responsibilities

• Complete pre‑certification, prior authorization and notification for third‑party and government payers for all pre‑scheduled elective inpatient/outpatient procedures and diagnostic testing.
• Communicate with insurance companies and/or physician’s offices to obtain pre‑certifications.
• Maintain compliance with regulatory requirements.
• Demonstrate Customer Focus (15) and expert Functional/Technical Skills (24) while providing pre‑certification evaluation of each scheduled inpatient or outpatient patient case.
• Comprehend the clinical aspect of the chart and apply it to ensure authorization of accounts.
• Maintain excellent customer service standards when interacting with physicians, physician offices, insurance representatives, patients, and co‑workers.
• Perform duties efficiently while ensuring patient confidentiality and privacy rights.

Qualifications

• High school diploma or GED required; Associate Degree in related healthcare or business field preferred.
• Medical Terminology Certification preferred.
• Two years of experience in Patient Access, Health Information Management, Physician Office, Billing, Collections, or Compliance required; applicable coursework may substitute for experience.
• Two years of previous insurance experience and/or pre‑certification experience preferred.
• Demonstrate knowledge of medical terminology and basic anatomy/physiology.
• Equivalent combination of education and experience will be considered.

Skills

• Ability to perform a variety of tasks, often changing assignments on short notice.
• Adept at multi‑tasking, organizing, prioritizing, and time management.
• Learn and work with multiple software/hardware products used in an average work day.
• Excellent verbal and written communication skills; excellent telephone skills.
• Maintain a professional demeanor in stressful situations.
• Adept with typical business office machinery.
• Build productive relationships with all contacts.
• Analytical skills to resolve simple to semi‑complex problems.
• Proficient in Windows‑based computer technology, including keyboarding/typing ≥35 wpm.
• Competencies: Customer Focus (15), Deal with Ambiguity (2), Composure (11), Peer Relationships (42), Patience (41), Compassion (10), Time Management (62), Interpersonal Savvy (31).

Schedule

9am‑5:30pm