Pre-Certification Special

POSITION SUMMARY The Pre-Certification Specialist is responsible for obtaining insurance authorization and insurance benefit eligibility verification for patients at Trinity Health in a prompt and accurate manner. The Pre-Certification Specialist ensures that authorization is obtained when needed for the length of the hospital stay and/or outpatient services. This position works collaboratively as part of the Revenue Cycle Program and Business Office to ensure clinical services are authorized based on insurance payer guidelines to minimize the reimbursement risks associated with providing care to patients. MINIMUM QUALIFICATIONS AND REQUIREMENTS Licenses and Certifications Required None Educational Requirements High School diploma or equivalent preferred. Experience Requirements Experience with third party payer billing regulations, reimbursement requirements, precertification, insurance eligibility verification, and/or utilization management is preferred. Working knowledge of CPT/ICD10 and medical terminology is preferred. Special Skills or Training Requirements Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers. Self-directed, attention to detail. Computer experience. Ability to navigate numerous websites for eligibility and prior authorization. Working knowledge of Microsoft Office Suite applications including Outlook, Word and Excel. Excellent written and oral communication skills. Ability to handle high workload volume. Must be flexible and demonstrate ability to be adaptable.

• POSITION SUMMARY

• The Pre-Certification Specialist is responsible for obtaining insurance authorization and insurance benefit eligibility verification for patients at Trinity Health in a prompt and accurate manner. The Pre-Certification Specialist ensures that authorization is obtained when needed for the length of the hospital stay and/or outpatient services. This position works collaboratively as part of the Revenue Cycle Program and Business Office to ensure clinical services are authorized based on insurance payer guidelines to minimize the reimbursement risks associated with providing care to patients.

• MINIMUM QUALIFICATIONS AND REQUIREMENTS

• Licenses and Certifications Required

• None

• Educational Requirements

• High School diploma or equivalent preferred.

• Experience Requirements

• Experience with third party payer billing regulations, reimbursement requirements, precertification, insurance eligibility verification, and/or utilization management is preferred.

• Working knowledge of CPT/ICD10 and medical terminology is preferred.

• Special Skills or Training Requirements

• Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers.

• Self-directed, attention to detail.

• Computer experience.

• Ability to navigate numerous websites for eligibility and prior authorization.

• Working knowledge of Microsoft Office Suite applications including Outlook, Word and Excel.

• Excellent written and oral communication skills.

• Ability to handle high workload volume.

• Must be flexible and demonstrate ability to be adaptable.