The Central Scheduling Team at Southern Maine Health Care is seeking a Pre-Certification Representative#with prior authorization and#strong patient registration experience. This position is Part Time with flexible/variable hours#and#days#based on business needs.
Must be available Monday-Friday between 6:00AM-5:00PM. Position Summary This position serves as a primary contact for Pre-Certification activities. Handling of patients accounts includes registration, medical necessity and prior authorization activities.
Incumbent must possess a high level of working knowledge regarding insurance carrier requirements. Position is responsible for confirming patients# insurance coverage, eligibility, collect benefits information and perform prior authorization for Outpatient services They must have exceptional verbal and written communication skills with a strong attention to detail; proven organizational skills required. They must conduct all interactions with patient, physician offices and other personnel in a courteous, respectful manner while maintaining confidentiality.
All tasks are required to be done per established protocols and accuracy standards while demonstrating the SMHC mission to improve the health and healthcare of the communities we serve. To be successful in this role, the employee must be competent, flexible and adaptive to changes in healthcare delivery and technology. # Required Minimum Knowledge, Skills, and Abilities (KSAs) High School graduate or GED preferred.
Demonstrated knowledge of medical terminology required.# Experience with an electronic medical record system preferred.
Demonstrated knowledge of insurance websites and ability to ascertain eligibility, authorizations and benefit details.# Demonstrated knowledge of medical insurance and their respective billing requirements (IE: Worker#s Compensation, Third Party# Liabilities, Medicare, Maine Care, and all commercial insurances)# Understanding of diagnostic and procedure coding systems IE: ICD-10-CM and CPT Codes/HCPS codes required.# Understanding the insurance precertification process required.# Strong interpersonal and telephone soft#skills required.# Advanced experience with emailing, keyboarding/typing and voice-mail systems required.
Previous success in positions requiring minimal supervision and strong personal initiative is desirable. Ability to work in a fast paced environment