Sleep Lab Pre-Cert Specialist

Job Description

Job Description

Position : Pre-cert Specialist

Department : Sleep Lab

Reports to : Department Supervisor

Job Summary :

• Complete intake and review of all incoming referrals / orders for all sleep studies
• Ensure required documentation is included in patient's EMR (office visit notes, referral / written order, patient demographics, current payer information)
• Pull insurance eligibility on all sleep study patients
• Create encounter / fin # on all sleep studies
• Request prior authorization for all sleep studies through the Prior Authorization Pool in Clinic Support through Powerchart
• Monitor Prior Authorization requests
• Communicate with referring / ordering providers regarding denied prior authorizations
• Once PA is approved, ensure Sleep Study Pre-cert in Included in patient's EMR complete charges and any patient financial responsibility
• All sleep study scheduling; IN FACILITY and HSATs
• Once scheduled, notify RT so that the electronic order can be initiated for provider electronic signature in Powerchart
• Complete pre- registration / admissions over the phone with all patients to be scheduled for an IN-FACILITY study; reviewing and / or partially completing all required registration and admissions paperwork
• Collect pre-procedure patient payments by phone or arrange (and monitor prior to procedure) for patient to come in prior to their study to make payment on all IN FACILITY patients
• Provide night tech with all required registration and admissions paperwork for patient completion and signatures on the eveing the patient is scheduled
• Complete and mail sleep study reminder letters
• Provide front desk with registration / admission paperwork and required questionnaires for all HSAT patients including any patient financial responsibility on their date of service
• Monitor G3 and Airview for completed sleep study diagnostic reports
• Ensure completed reports are actually complete (contains required time for recording data, includes the providers IMPRESSION, PLAN and signature
• Ensure that completed sleep study reports are scanned or imported to patients EMR
• Once the completed sleep study reports are included in the patients EMR, notify RT to validate the electronic order so that their chart will drop
• Communicate with referring / ordering provider regarding any issues during their patients sleep study (Patient left AMA, date incomplete and needs retest, etc.)
• Communicate with Clinic Management / RT regarding MSLT scheduling (need for daytime tech)
• Communicate with Clinic Management / RT regarding INSPIRE related testing (need for INSPIRE tech)
• Communicate with Clinic Management / RT regarding meals for MSLT patients
• Communicate with Clinic Management and night tech regarding patients with special needs (minors and those requiring another person to be present during their study, those requiring oxygen, unsteady gait, vision or hearing impaired, needs a translator, etc.)
• Provide sleep study reports to referring / ordering provider when or if requested
• Communicate with sleep study biller in order to ensure all billing guidelines are met