What are the responsibilities and job description for the Pre-Certification Rep position at Elliot Health System?
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POSITION SUMMARY
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To ensure that precertification is completed for patients which is required by insurance payors.
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KEY RESPONSIBILITIES
- Obtains insurance verification and precertification for applicable patients based on payor requirements, and documents in system.
- Interacts with staff to share information and receive updates regarding patient status or procedure.
- Interact with Patient Accounts to resolve billing and precertification issues. Provides supportive documentation as needed.
- Verifies all self-pay accounts and conducts any necessary research to determine absence of any other insurance.
- Obtains approval to ensure that clinical information is provided to insurance companies and authorization is complete.
- Educates staff on the process required for precertification.
- Fills out all necessary authorization request forms and submits to insurance companies.
- Verifies accuracy of information by identifying patient’s name and date of birth, which may involve the use of patient files.
- Researches ICD-9 and ICD-10 coding (to precert only) and outpatient diagnostic and clinic records.
- List the diseases/conditions documented within the current admission or office visit.
- Develops the proficiency necessary on current equipment used including word processors, mainframe computer terminals, or other such devices.
- Follows specified procedures for dispatching finished reports to designated person(s) for approval and signature, and for dispatching copies to appropriate parties.
- Maintains all logs, records, or other files necessary to accurately track production for present and future references.
- Exercises care in the use and operation of Elliot Hospital equipment and reference materials.
- Ensures routine preventive maintenance to ensure continued functioning of equipment.
- Maintains work area in a clean and organized manner.
- Ensures confidentiality of employee, legal, client/patient, budget and all company matters.
- Monitors schedule and staff messages for anything requiring authorization.
- Maintains files for easy retrieval of material and secures confidential information.
- Answers telephone, assists callers, takes messages, or refers call to appropriate person.
- Reports all equipment failures or impending failures promptly to the Manager.
- Schedules appointments once required prior authorizations are obtained.
- Coordinates with patients to schedule and provide updates.
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REQUIRED KNOWLEDGE & SKILLS
- Requires the ability to perform repetitive or routine duties working from detailed instructions and under standard procedures. Requires the making of minor decisions.
- Ability to operate a personal computer and related software.
- Ability to accept constructive feedback and initiate appropriate actions to correct situations.
- Ability to establish a cooperative, collaborative working environment and maintain effective communications and positive working relationships within the department, with other employees and the public.
- Ability to work with frequent interruptions and respond appropriately to unexpected situations.
- Ability to endure periods of heavy workload or stress.
- Ability to prioritize workload.
- Ability to type approximately 55 words per minute.
- Ability to deliver patient care in a manner that is appropriate to patient’s age, physical ability and intellectual development. Must demonstrate proficiency in assessing urgency level and adapting care to meet the needs of the patient population served, infant, child, adolescent, adult and geriatric.
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EDUCATION/EXPERIENCE/LICENSURE
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Education: High school diploma or equivalent with courses in typing and computer skills required; medical terminology preferred.
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Experience: Experience in customer service relations and office experience preferred.
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Certification/Licensure: N/A
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Software/Hardware: N/A
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OTHER REQUIREMENTS
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Schedule: Monday - Friday, days and early evenings as needed.
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Other: N/A
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