PRE-CERTIFICATION SPECIALIST
3170 S. Kettering Blvd. Building B Moraine, OH 45439
DEPT: PRE-CERTIFICATION
Full-Time / DAY SHIFT / 9:00 AM - 5:30 PM
The Pre-Certification Specialist is responsible for the completion of pre-certification, prior authorization and notification for third party and government payers for all pre-scheduled elective inpatient/outpatient procedures and diagnostic testing. He/she is responsible for communicating with insurance companies and/or physician’s offices to ensure the pre-certifications are obtained. He/she must maintain compliance with regulatory requirements.
The Pre-Certification Specialist must demonstrate Customer Focus and expert Functional/Technical Skills while providing pre-certification evaluation of each scheduled inpatient or outpatient patient case. The Pre-Certification Specialist must comprehend the clinical aspect of the chart and how to apply it to ensure authorization of the accounts. The Pre-Certification Specialist is required to maintain excellent customer service standards at all times in order to effectively communicate with physicians, physician offices, insurance representatives, patients, and co-workers. Pre-Certification Specialists are required to efficiently perform all duties while ensuring patient confidentiality and privacy rights.
Education: High school diploma or GED required. Associate Degree in related healthcare or
business field preferred.
Certification: Medical Terminology Certification preferred.
Experience: Two years of Patient Access, Health Information Management, Physician Office, Billing, Collections or Compliance experience required. Applicable class work may be substituted for previous work experience.
Two Years of previous insurance experience and/or pre-certification experience preferred.
· Demonstrate knowledge of medical terminology and basic anatomy/physiology.
· Equivalent combination of education and experience will be considered.
Skills/Other:
1. Ability to perform a variety of tasks, often changing assignments on short notice.
2. Must be adept at multi-tasking, organizing, priority, and time management.
3. Will be required to learn and work with multiple software/hardware products to be used during the course of an average work day.
4. Must possess excellent communication skills, both verbal and written.
5. Most possess excellent telephone skills.
6. Must be able to maintain a professional demeanor in stressful situations.
7. Must be adept with machinery typically found in a business office environment.
8. Able to build productive relationships with all contacts.
9. Must have analytical skills to resolve simple to semi-complex problems.
10. Must be proficient in Windows-based computer technology, including keyboarding and typing at least 35 wpm.