Precertification Specialist II

Job Description

POSITION SUMMARY:

Responsible for verifying funding for each patient, opening EHR episodes, completing reviews for continued authorization and entry of authorizations in a timely fashion, verifying services provided and billable diagnoses, and assisting management with denial recoupment and appeal. Reports to and functions under the direction, instruction, and supervision of the Provider Services Supervisor.

QUALIFICATIONS:

Associate degree from accredited college or two years of experience in the health care field. Needs to be able to read and write proficiently; needs to be able to utilize Microsoft Excel. Avatar experience preferred.

PHYSICAL DEMANDS:

Abilities in reaching, bending, talking, , sitting, carrying, standing, grasping, fine hand coordination, ability to read and write, and the ability to remain calm under stress. Ability to reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl. Must be capable of lifting 20 pounds alone.

WORK ENVIRONMENT:

General office, health care setting. Most work is completed while seated at desk using standard office equipment. Fast paced team approach. Multi-tasking ability requires above average time management skills.

FUNCTIONAL RESPONSIBILITIES INCLUDE:

• Verifies fund source and eligibility and responds to emails regarding changes or updates in funding as soon as they are known.
• Relays all duties completed and those that need follow up on email at end of shift.
• Maintains timely communication with other Gracepoint staff regarding charge input issues.
• Compiles necessary and requested data to manager, supervisor, and other departments as assigned or requested.
• Completes any necessary documents to close a patient record.
• Assists in appeals process for denied authorization and claims.
• Maintains good documentation on all forms and good communication with other managed care staff, as well as programs providing service(s), regarding funding & authorization issues.
• Completes FASAMS.
• Verifies diagnosis is accurately entered for billing purposes.

• Enter the episode of care, demographics, eligibility, diagnosis, and services into the Gracepoint EHR.
• Determines the needed information to complete the required fields in Gracepoint’s EHR with data from external EHRs.
• Completes the “AdventHealth Weekly File” timely and accurately enters data into Gracepoint EHR. This would include an episode of care if needed, patient demographics, eligibility, diagnosis, and services whether though automation or manually entered.

COMPLIANCE RESPONSIBILITIES INCLUDE:

• Adheres to all applicable federal, state, local, and company-maintained standards of compliance, ethics, and policies concerned with the administration and delivery of agency services.
• Meets deadlines, requirements, and expectations as established by the supervisor, agency, and department.
• Completes administrative functions and data entry timely and accurately.

CUSTOMER SERVICE RESPONSIBILITIES INCLUDE:

• Provides exceptional customer service in all communications and interactions with staff, general public.
• Maintains confidentiality and remains calm under stress.
• Assists staff with support in all areas of functional responsibility in a courteous, supportive manner.
• Maintains and exhibits servant leadership qualities and exceeds customers’ expectations.

FISCAL RESPONSIBILITIES INCLUDE:

• Effective, efficient use of agency resources, systems, equipment, and processes.
• Continuous focus on cost savings initiatives across the responsibilities and deliverables.
• Effective use of time management to avoid overtime and budgetary issues.