The Pre-Cert Coordinator supports the complete and timely work flow of the company’s authorization process. The individual is responsible for obtaining and processing all necessary information required to obtain precertification or authorizations, as required by payors.
Essential Duties and Responsibilities:
Verifies all insurance benefits for all procedures and specialty medications.
Coordinates with insurance providers, physicians and patients to obtain pre-authorizations on all specified procedures and specialty medications. Documents these findings in patient charts.
Manages all specialty pharmacy processing and delivery for specified medications, once authorization is obtained (NE Region Only).
Reviews clinical data matching it against specified medical terms and diagnoses and follow established procedures for authorizing request.
Files completed precertification requests as per established procedures.
Work with other departments to ensure prior authorization protocols are in place.
Coordinates with physicians, insurance companies and patients.
Works as patient liaison between the insurance companies and the physicians at the Company.
Communicates necessary patient information with contracted ASC’s and other key stakeholders.
Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
Participates in and complete all required trainings and in-services.
Performs other duties as assigned.
Minimum Qualifications:
High School Diploma, or equivalent WITH a minimum of two (2) years related experience; OR an equivalent combination of education and/or experience.
Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
Must have excellent written and oral communication skills, including exceptional customer service.
Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
Must be able to work individually as well as within a team.
Must be able to follow both verbal and written instructions.
Must be able to work a flexible schedule.
Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
Must be able to multi-task and prioritize.
Must demonstrate extreme attention to detail.
Must possess strong organization skills.
Must be able to problem solve and use reasoning.
Must be able to meet predefined quality standards.
Must maintain and project a professional attitude and appearance at all time.
Must have a working knowledge of CPT and ICD-10 coding rules.
Must have a solid foundation of insurance knowledge and guidelines for third party payers.
Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.
Preferred Qualifications:
Two (2) years’ experience working with an Electronic Medical Record (EMR).
Two (2) years’ Pre-Cert Experience.
Medical Coding Certification
Driving/Travel:
The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.
Numbers & Facts
Location
Pensacola, FL
Skills
Clinical Dataunmatched
Clinical Validationunmatched
Communication Skillsunmatched
Continuous Improvementunmatched
Current Procedural Terminology (CPT)unmatched
Customer Support/Serviceunmatched
Detail Orientedunmatched
Electronic Medical Recordsunmatched
Establish Prioritiesunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Healthcareunmatched
High School Diplomaunmatched
ICD-10unmatched
Insuranceunmatched
Medical Codingunmatched
Medical Diagnosisunmatched
Medical Recordsunmatched
Medical Terminologyunmatched
Medical Treatmentunmatched
Medicationsunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Outlookunmatched
Microsoft PowerPointunmatched
Microsoft Wordunmatched
Multitaskingunmatched
Organizational Skillsunmatched
Patient Care Authorizationsunmatched
Patient Chartsunmatched
Pharmacyunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
Procedure Developmentunmatched
Quality Metricsunmatched
Regulationsunmatched
Third-Party Payerunmatched
Time Managementunmatched
Writing Skillsunmatched
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