Pre-Certification Clerk Jobs

Mission statement
Superior health care and exceptional service for each person, every time.
Vision
To be a vibrant and thriving five-star center for health, serving as our community's first choice for health and wellness.
Our C.A.R.E. Values

• Accountability - I will be trustworthy, responsible, and dependable while taking ownership of my actions.
• Compassion - I will treat everyone with kindness, acceptance, empathy, and understanding.
• Respect - I will value the feelings, wishes, rights, and traditions of everyone without judgment.
• Excellence - I will strive to understand and exceed the expectations of others.

:

• Fulltime-Days

Benefits:
Medical Insurance- Three different plans to choose from
MASA- Medical Transportation Solutions
Health Reimbursement & Savings Account
Flex Spending Account/Dependent Care Spending Account
Dental
Vision
Identity Protection-Free
Hospital Indemnity
Life Insurance-Free
LTD/STD-Free
Voluntary Life & AD&D
403 (b) Retirement Plan- 4% employer contribution
ETO
EIB-Hospital contribution
JOB DESCRIPTION: Pre-Certification Clerk
JOB SUMMARY:
The Pre-Certification Clerk is responsible for obtaining authorizations from insurance companies for hospital services along with verifying patient eligibility and benefit information for the specific services to be performed.
ESSENTIAL ACCOUNTABILITIES:

• Provides appropriate documentation and follow up to patients, physician offices, case management/utilization review and payers regarding authorization/referral deficiencies.
• Verifies insurance information through payer contacts via telephone, online resources, or electronic verification systems.
• Corrects and updates all necessary data to assure timely, accurate billing submission.
• Identifies private-pay and/or under insurance patients and escalates accounts to a Patient Financial Service Representative.
• Obtains/verifies pre-certification and/or authorization prior to services.
• Identifies payer authorization/referral requirements.
• Maintains accountability for accuracy of data collected and entered into the computer system.
• Contacts insurance carriers or other physician offices to obtain prior authorizations.
• Maintains up-to-date information on various insurance companies and any relevant changes.
• Communicates important insurance data to appropriate staff.

Department Specific Accountabilities:

• Must produce accurate and complete work.
• Other duties as assigned.
• Follow and abide by all hospital policies and procedures to maintain employment with the hospital.

Other Job Accountabilities:

• Interacts with nurses, coders, and other clinical staff to gather information needed for precertification, prior approval, or pre-determination.
• Will perform back up duties for the Patient Advocate / Precertification position. Those duties could include the following but are not limited to the following areas. Inpatient precertification, PT/OT/ST benefits and precertification, running VA and Bluestem reports, performing emergency care notifications for VA patients coming in through the ER and Walk-In-Care, running surgery schedule to endure precertification’s are received.

QUALIFICATIONS:
Education:

• High school education required.

Experience:

• Two or more years medical prior authorization experience preferred.
• Two or more years’ experience in a medical related field required.
• Knowledge of basic medical terminology.

Skills:

• Ability to change duties at a moment’s notice.
• Detail oriented with above average organizational skills.
• Exceptional follow-through and job execution skills - obtaining authorizations timely and following accounts through payment.
• Ability to multitask and remain focused while managing a high-volume, time-sensitive workload.
• PC skills required to become proficient in the use of a variety of computer-based systems.
• Plans and prioritizes to meet deadlines.
• Must be familiar with office equipment typically found in a business office environment.
• Ability to work in a changing environment.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability, status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.