Data Intake And Pre-Cert

The Pre-Cert Specialist will work with the Data Intake Manager to oversee the insurance benefit verification and authorization process for hyperbaric and/or wound care services requested for 33+ locations. This individual will be responsible to report to facilities all specific requirements that must be in place to ensure financial reimbursement for services rendered. In addition, this individual will assist with all senior management in reporting and analysis of Pre-Certification results.
What We Offer:

• Competitive compensation
• Generous Paid Time Off and Paid Holidays
• Employer-Paid Basic Life Insurance, AD&D and Short-Term Disability
• Voluntary Accident, Critical Illness and Hospital Indemnity Plans
• Pet Care Discount Program
• Health Savings Account (with employer match) and Flexible Spending Accounts (General Purpose, Limited Purpose and Dependent Care)
• Medical, Dental and Vision Insurance
• Monday - Friday schedule, no weekends
• Internal ongoing educational/training opportunities
• 401(k) Retirement Plan (with employer match)
• Continuous coaching & mentorship
• Voluntary Buy-Up Life Insurance (for self, spouse & children), Short-Term Disability and Long-Term Disability
• Employee Assistance Program
• RestorixHealth is proud to provide employees with a comprehensive and attractive benefits program which includes the following:

Primary Responsibilities:

• Inventory all paperwork (hard copied and electronically) for any need for review or auditing.
• Pull completed medical records off Electronic Medical Record system and review prior to insurance request.
• Report all results to the appropriate facilities to clarify any requirements necessary to meet financial obligations for reimbursement.
• Identify types of requests for 33+ centers and determine if all necessary documents are available to initiate pre-cert request.
• Request benefit level insurance verification as well as request Pre-Certification and/or pre-determination to ensure that services rendered meet the insurance carrier’s requirements for reimbursement.

Additional Responsibilities:

• Log all findings in an excel spreadsheet for reporting and analysis.
• Share data with AR team to aid in appeals for denied cases.
• Daily feedback to centers to report all outstanding requests to determine where they are in the
• Re-verification of all actively treated hyperbaric and/or wound care patients on a monthly basis to determine if there are any changes to their benefit or reimbursement policies.

pre-certification process
Education and Technical Skills:

• College education with a major in a healthcare discipline preferred
• Experience with Wound Docs system or other Electronic Medical Record (EMR) system
• Experience with Great Plains system preferred
• 4 years healthcare industry experience preferred
• Basic MS Excel, MS Word and MS Outlook skills

Additional Eligibility Qualifications/Competencies:

• Must be able to multi-task in a fast-paced environment and meet deadlines
• Must possess excellent interpersonal, written and verbal communication skills
• Must have excellent project management skills
• Must be organized and detail oriented
• Strong interpersonal/communication skills
• Comfortable with multi-tasking
• Must possess problem solving skills
• . Must be able to work independently

Physical Requirements:
This position requires periods of time in which sitting, standing, use of hand and foot motion, vision, hearing, summarizing, focusing with frequent interruptions along with other physical, sensory and cognitive sensory functions are required.
Note: The above is intended to describe the general content of and requirements for the performance of this job. It is not construed as an exhaustive statement of duties, responsibilities or requirements and may change at any time.
All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. RestorixHealth is an EO employer – M/F/Veteran/Disability