The South Bend Clinic

Precertification Specialist

Location US-IN-South Bend
Location : Name University Commons Physicians Administrative Office
Department
Business Office
Schedule
Monday- Thursday 8-5 Friday 8-4
HRS/PP
1.0 (80 Hours)

Job Description

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POSITION: Precertification Specialist

 

DEPARTMENT: Various

 

REPORTS TO: Practice Manager

 

REVIEWED BY: Practice Manager and Human Resources

 

STATUS: Non-Exempt

 

REVIEW CATEGORY: Non Clinical Patient Care

 

REVISION DATE: 03/01/2020

 

SUPERCEDES: 09/25/2017

 

 

POSITION SUMMARY: Obtains insurance precertifications and prior authorizations for patients prior to rendering services such as, but not limited to, procedures, injections, medications, infusions, DME, surgery, and diagnostic testing and imaging appropriate for department.

 

POSITIONS SUPERVISED: None.

 

ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES:

  1. Obtains insurance pre-certification for all office procedures, medications, infusions, injections, surgery, diagnostic testing, DME, imaging, and medications.
  2. Performs timely documentation of status work in applicable electronic platform.
  3. Schedules patient procedures and/or tests with appropriate departments including involved parties.
  4. Obtains referrals as necessary.
  5. Ensures patients are informed of scheduled tests/procedures and insurance requirements prior to completion.
  6. Assists in benefit verification with patient insurance company so patient knows ahead of time what they will be financially responsible for, where applicable.
  7. Coordinates precertification and authorization processes with scheduling staff so appointments can be made in a timely manner.
  8. Obtains any and all pertinent clinical health information to process authorizations, referrals, and precertifications.
  9. Reinforces instructions and explanations of tests/procedures to patients per protocol.
  10. Documents all pre-certifications/authorizations in appropriate electronic platform.
  11. Verifies demographic information, including insurance when scheduling and/or obtaining pre-cert.
  12. Handles phone calls from patients regarding their insurance requirements for tests/procedures if applicable.
  13. Compiles necessary reports regarding pre-certification.
  14. Communicates with Business Office regarding verification of complex insurance and precertification requirements.
  15. Maintains good working relationships with all contacts.
  16. Utilizes up-to-date coding information.
  17. Takes initiative to seek out tasks and duties or to assist others as necessary
  18. Exhibits computer systems knowledge and proficiency as necessary to perform job functions.
  19. Demonstrates the attitudes and behaviors of The South Bend Clinic Service Standards.
  20. Performs other duties as assigned when appropriate.
  21. Adheres to HIPAA guidelines set forth in Clinic policies and procedures.

POSITION REQUIREMENTS:

Education/Certification/License:
High school diploma or equivalent required.

 

Knowledge, Skills, and Abilities:
Prior computer experience and ability to navigate in systems required. Prefer previous procedure scheduling with strong knowledge of insurance requirements and prior medical office experience. Position requires constant and frequent sound judgment and response. Must have excellent phone communication skills; detailed focus and quality follow through; and ability to successfully multi-task.

 

Special Demands/Requirements:
None

 

ADA JOB REQUIREMENTS:
Physical Demands:

Climbing/Balancing/Stooping/Reaching/Fingering/Grasping/Feeling/Talking/Hearing/Repetitive Motions

 

Physical Requirements:

Light Work - Exerting up to 20lbs of force occasionally, and/or up to 10lbs of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated light work.

 

Visual Acuity:

Close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer terminal, extensive reading.

 

Environmental Conditions:

The worker is subject to inside environmental conditions.

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