Precertification Specialist

Job Description

Job Description

Summary

The Pre-Certification Specialist is responsible for supporting the revenue cycle process by obtaining authorizations and referrals as the referral flows through the pre-certification process and according to the requirements of the insurance payer. Prompt and precise communication is a necessity in this high volume time sensitive work environment.

Essential Functions

• Verifies insurance coverage to ascertain deductible and coinsurance amounts if necessary, obtaining precertification / authorization for office visits, surgeries, MRI’s, specialty injections, and other services that are provided under the umbrella of Dean McGee Eye Institute
• Supports providers, clinicians and other staff in a seamless process prior to the patient being seen for their service.
• Updates insurance policy information in the Epic platform if required.
• Completes all referrals and authorizations and other data elements as required by the Epic system flow which in turn generates information to other departments to complete the registration and scheduling activity.
• Verify receipt of all necessary pre-authorization documents prior to treatment.
• Document and communicate with external departments to resolve issues and ensure accurate financial and demographic information is entered prior to service.
• Assist management in development and creation of pre-certification policies and procedures
• Maintains effective working relationships with patients, physicians, insurance representatives and other medical support staff.

Required Education and Experience

High School Diploma or equivalent required.

Customer service experience and basic computer skills required, preferably in a Windows environment with electronic medical records software.

Preferred Education and Experience

2 to 5 years of Epic experience

Advanced knowledge and experience of ICD 10 and CPT coding

Medical office experience required

Knowledge of Ophthalmic terminology

Pre-certification experience

Continuing education

Competencies

Work Environment

This is a clerical job in a healthcare clinical setting. The Pre-Certification Specialist will primarily work in an office setting but may be required to walk to other areas of the clinic and may be exposed to contagious illnesses due to patient interactions.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is occasionally active and requires standing and walking for the duration of the shift. In addition to the aforementioned demands, this position requires sitting for extended periods of time.

Position Type and Expected Hours of Work

This is a full-time position working primarily daytime hours Monday through Friday; however, some evening and weekend work may be necessary on occasion.

Other Duties

Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.