40 hrs per week M-F 830a-5p
WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION
Insurance Precert Representative
MAIN FUNCTION:
Protects hospital payments for inpatient admissions and outpatient services requiring precertification. Ensures all proper notifications of admissions have occurred. Ensures all scheduled outpatient services requiring prior authorization/precertification have the correct and appropriate authorizations prior to services being rendered.
RESPONSIBLE TO: The Director and Manager of Patient Access
MUST HAVE REQUIREMENTS:
Experience working in a physician’s office or hospital setting with third party payers to obtain authorization for hospital services
Proficient in medical terminology
Strong organizational skills and demonstrated ability to work independently.
Current computer or Meditech skills
Demonstrated effective interpersonal and oral communications skills
No written disciplinary action within the last 12 months.
PREFERRED ATTRIBUTES:
2 years previous experience in a physician office or hospital setting
Prior medical billing and/or coding knowledge
Post High School education in medical office skills
Ability to utilize internet and other technology
Denotes ADA Essential
Follows appropriate service standards
POSITION EXPECTATIONS:
- Receives notification of services/testing scheduled to be performed at the hospital
Effectively navigates payer websites to verify insurance benefits and obtain necessary pre-certs per payer guidelines
Contact third party payers when necessary to request authorization for services ordered
Enters verification information in Meditech system and physician office EMR
Accesses the physician’s EMR to obtain clinical information pertaining to the ordered service. Must be able to review the EMR to obtain prior testing results (ie, lab values, imaging results, etc)
Initiates the precertification notification for all inpatient admissions
Verifies completion of all needed pre-certs for outpatient procedures
Communicates precertification denials to physician office and WCH scheduling
Maintains a professional relationship with the physician’s and their office staff
Keeps an organized record of precertification worklists
Communicates effectively with other departments all information necessary to complete the precertification process
Functions successfully in a team oriented work environment
40 hrs per week M-F 830a-5p
40 hrs per week M-F 830a-5p