Pre-Cert-Insurance Authorization Specialist- Central Scheduling

Date Published: 03/24/2024

REPORTING RELATIONSHIPS

Reports to: Central Scheduling Outpatient Precert Supervisor

GENERAL SUMMARY

Works under the supervision of the Supervisor of Outpatient Precert Central Scheduling. The Pre-Cert/Insurance Authorization Specialist primary job functions are to perform professional orderly, efficient insurance verification and pre-cert for outpatient procedures and same day surgery. The Pre-Cert/Insurance Authorization Specialist responsibilities are to verify insurance coverage/eligibility, obtain pre-certification/prior authorization, benefit information through online systems and calling the insurance companies. Is responsible for notifying provider office when a procedure is pending to have the patient reschedule. Is responsible for safeguarding the public relations and confidentiality of the hospital and its records by consistent professional conduct. Performs other duties as assigned.

QUALIFICATIONS

Education:

• High School Diploma or successful completion of an equivalent High School Exam Required

Licensure:

• None

Experience:

• Six to twelve months of related work or hospital billing experience required

• Experience with computer preferred

• Insurance knowledge preferred

• Medical terminology preferred

• Scheduling knowledge preferred

• Knowledge of CPT/ICD 10 codes preferred

Interpersonal Skills:

• Positive service oriented interpersonal and communication skills required.

• Must demonstrate knowledge of the principles of growth and development, and posses the ability to assess data reflective of the patient status.

• Interpret the appropriate information needed to identify each patient requirements relative to their age specific needs and to provide care needed as described in areas, policies, and procedures.

Essential Technical/Motor Skills:

• Inputting data, typing, copying, calibrating equipment, speaking clearly, answering the telephone, precise eye/hand coordination, fingering fine dexterity. Must be able to multi task

Essential Physical Requirements:

• The physical demand level for this position is light to medium.

• Occasionally must lift 35 pounds or less.

• Stands and/or walks one to two hours per day; sits for five to eight hours per day continuously when entering required data into online systems.

• Bending, kneeling, stooping, standing, repetitive activity, and reaching above shoulder level occasionally required.

• Must have the ability to use hands for repetitive grasping, fine manipulation, and pushing and pulling.

Essential Mental Requirements:

• Analytical ability necessary in order to locate and document patient insurance information, communicate with the general public and the customer in conjunction with job duties.

• Works under close supervision only occasionally and occasionally without the assistance of other personnel.

• Requires the ability to continuously cope with deadlines under pressure to have attention to detail and to be able to concentrate when using the Information Systems and scheduling system for significant periods of time.

• Occasionally must cope with irregular activity schedules. Analytical, assessing, evaluation, explaining, teaching, problem solving, reasoning, memorizing, and interpreting numbers skills are necessary.

Essential Sensory Requirements:

• Good vision is needed when entering data in the Information Systems and scheduling system.

• The ability to hear and speak clearly is continuously required when dealing with patients, physician/offices, insurance companies and customers.

Exposure to Hazards:

• Normal office environment with little exposure to excessive noise, dust, temperature and the like.

Other:

• Must be familiar with and have the ability to use all relevant office equipment including, but not limited to: the EMR system, Scheduling system, SOMC Clinical Portal, Microsoft Office Suite, and Insurance sites

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS

The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

• Collects accurate financial, demographic and clinical data involving interaction with patients, physicians, insurance companies and outside agencies to meet the registration/precert standard in all systems used by Registration/Central Scheduling.

• Verifies coverage and eligibility, obtains Pre-certifications/Prior Authorizations on MRI, CAT Scan, Cardiac Testing Home Care and or any Outpatient test, oupatient surgeries, and procedures that require

• Collects and maintains various department records, logs and statistical date timely and accurately as identified by the Central Scheduling Supervisor. Documents all correspondence telephone calls and account activity.

• Assists in training and education of employees.

• Obtain clinical notes for outpatient testing and outpatient surgery for insurance companies requirements

• Reviews and works reports/work list for financial reimbursement

• Reviews the Surgery Schedule for authorization and follows up with the physician office if it is not notated in the system with the required time

• Performs other duties as assigned

Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status.

Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.