Precertification Representative

At Children’s Wisconsin, we believe kids deserve the best. Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

About the role

Initiates contact with insurance, third-party billers, physicians and patients/families to obtain precertification and authorization for all inpatient and outpatient services. Pre-registers patients as needed by calling patient families or using department protocol. Ensures that all patient accounts flow through the billing cycle without errors caused by lack of authorization/precertification, insurance verification, or incomplete or inaccurate demographic information or other registration-related errors which may cause the receivable to remain unpaid or written-off.

Responsibilities

• Initiates precertification and authorizations online, by phone, or via written documentation for all day surgeries, radiology procedures, therapies, psychiatry services, and other outpatient services as defined by payer-specific requirements.
• Contacts insurance companies, primary care physicians, and patient families to secure referrals for patients with out-of-network insurances.
• Enters referral and precertification/prior authorization information into Epic both timely and accurately.
• Proficient in Financial Verification Representative essential functions.
• Completes Ambulatory Clinic deemed/communication tool according to appropriate clinic protocol.
• Identifies the need for signatures required for consent for treatment and financial agreement to pay.
• Identifies referrals to financial counselors based on CHW administrative guidelines and adheres to the Financial Clearance self-pay process as appropriate.
• Helps educate patient/guardian/parent about the managed care process and means of obtaining valid referrals and authorizations.
• Participates in quality improvement initiatives, training sessions, and department meetings.
• Adheres to all CHW and Patient Access policies, procedures, and standards.
• Ensures confidentiality to our customers by creating and maintaining a secure environment in compliance with HIPAA.
• Utilizes Language Interpretation phone system for non-English speaking patients and families.
• Manages assigned work queues to ensure accuracy and completion per department guidelines and performs other duties as assigned.

Requirements

• High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).
• 2+ years of experience in registration, scheduling, or administrative support experience in a healthcare setting or a business environment.
• 1+ years experience as a Financial Verification Rep preferred.
• Experience with insurance referral and authorization processing required in lieu of Verification Rep experience.
• Epic experience preferred.
• Prior experience working in a Windows environment preferred.

Skills

• Excellent organizational, analytical, and prioritizing skills necessary to work in a fast-paced environment with multiple tasks done simultaneously.
• Excellent communication and interpersonal skills necessary to gather and share information with families and team members in a courteous, professional, and confidential manner.
• Ability to maintain positive communication skills during stressful situations.
• Analytical ability to determine the anticipated patient liability and ascertain need for financial counseling.