Precertification Specialist

Summary/Objective

The Pre-Certification Specialist is responsible for pre-certification of patient appointments and procedures according to DMEI protocol.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

• Verifies insurance coverage to ascertain deductible and coinsurance amounts, obtaining precertification/authorization for office visits, surgeries, MRI's, specialty injections, and other services as needed.

• Updates insurance policy information in Practice Management system(s) as required.

• Verify receipt of all necessary pre-authorization documents prior to treatment.

• Provide patients with estimated written documentation of covered therapy benefits per the patient's insurance coverage when applicable.

• Document and communicate with external departments to resolve issues and ensure accurate financial and demographic information is entered prior to service.

• Assist management in development and creation of pre-certification policies and procedures

• Maintains effective working relationships with patients, physicians, insurance representatives and other medical support staff.

Competencies

• Serving Others

• Integrity

• Respect

• Leadership

• Accountability

• Action Oriented

• Team Oriented

• Professionalism

• Continual Learning

• Informing

Supervisory Experience

This position has no supervisory responsibilities.

Work Environment

This is a clerical job in a healthcare clinical setting. The Pre-Certification Specialist will primarily work in an office setting but may be required to walk to other areas of the clinic and may be exposed to contagious illnesses due to patient interactions.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This position is occasionally active and requires standing and walking for the duration of the shift. In addition to the aforementioned demands, this position requires sitting for extended periods of time.

Position Type and Expected Hours of Work

This is a full-time position working primarily daytime hours Monday through Friday; however, some evening and weekend work may be necessary on occasion.

Required Education and Experience

High School Diploma or equivalent required.

Customer service experience and basic computer skills required, preferably in a windows environment with electronic medical records software.

Preferred Education and Experience

Advanced knowledge and usage of ICD and CPT coding

Medical office experience required

Knowledge of Ophthalmic terminology

Pre-certification experience

Continuing education

Additional Eligibility Qualifications

None for this position

AAP/EEO Statement

The Dean McGee Eye Institute is an Equal Opportunity, Affirmative Action M/F/V/D employer.

Other Duties

Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.