St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The precertification specialist is responsible for contacting health insurance companies prior to procedures, testing or admission to the hospital to verify coverage either online or by telephone. The precertification specialist is also responsible for relaying precertification information to performing facility and for facilitating appeals if initial approval denied. Excellent phone skills and computer skills needed. Previous medical terminology back round would be helpful. JOB DUTIES AND RESPONSIBILITIES: ESSENTIAL FUNCTIONS: Receives instructions from the physician regarding what procedure or testing is needed. Obtains precertification/preauthorization from insurance companies prior to procedure or testing utilizing an online application or contacting the insurance company by telephone. Verifies patient eligibility and coverage for the procedure using an online application or by telephone. If the patient is not eligible on date of service or procedure is not covered, this information is relayed to the physician and the patient. Maintains online log of patient’s requiring precertification. Maintains working knowledge of Navinet (online precertification application) Demonstrates competency in assigned areas of responsibility. Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services. Maintains detailed knowledge of computer software systems as it relates to job functions. Takes an active role in facilitation team approach to functions within the department: -Attends departmental meetings -Actively participates as a team member in resolution of problems as they are Identified -Analyzes current procedures, bringing suggestions for improvement to the attention Of team members and supervisor consideration -Document authorizations in medical record and provide to appropriate sources. Proficient in Electronic medical record program used in office. Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information. Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements. Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external). Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety. Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices. Complies with Network and departmental policies regarding attendance and dress code. Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated. Contacts Central Scheduling, Patient Access Department, and patient, to relay precertification information. OTHER FUNCTIONS: Assist other staff as needed. Other related duties as assigned. PHYSICIAL AND SENSORY REQUIREMENTS: Sitting up to eight hours a day. Continually use fingers for typing and writing. Routinely use upper extremities. Stoop, bend and reach above shoulder level regularly. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone calls. Position also requires viewing computer screens and typing for long periods of time. POTENTIAL ON-THE-JOB RISKS: Repetitive motion injury of the wrist due to frequent computer use (adaptive modification of keyboard available). Identified Risks: Employees who work in patient care areas where they may have potential exposure to patients with suspected or proven tuberculosis (TB) must have the ability to wear a particulate respirator and be fit-tested in compliance with the current recommendations from the CDC (enforced by OSHA) or must provide physician documentation as to the inability to wear a particulate respirator. SPECIFIC PROTECTIVE EQUIPMENT AVAILABLE: NONE MOST COMPLEX DUTY: Ability to maintain a working knowledge of insurance and precertification requirements. Reviewing a patient’s electronic chart for information that is needed when requesting precertification. Ability to communicate effectively with physicians and team members. Ability to prioritize work in an environment of constant change while meeting the needs of the office. SUPERVISION (RECEIVED BY AND/OR GIVEN TO): Practice Administrator COMMUNICATIONS: Must possess the ability to communicate effectively and appropriately with patients, insurance companies, physicians and team members. Must be assertive and pleasant in order to gather accurate and complete data. Must be able to convey information to patients in a way that they can understand and also must know when to listen. Must be able to remain calm, tactful and even-tempered in a variety of situations. ADDITIONAL REQUIREMENTS: Must demonstrate a positive attitude. Must be customer service driven, motivated and ambitious. Enjoy working with people and have the ability to collaborate with peers to solve problems. Must be proactive. MINIMUM QUALIFICATIONS EDUCATION: High School diploma required. TRAINING AND EXPERIENCE: Previous precertification experience helpful. Medical coding and terminology experience preferred. WORK SCHEDULE: Day, middle or night shift with varying hours based on the needs of the department. Travel to satellite offices may be necessary. REVISED: 10/15 Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer. Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300 outpatient sites. With annual net revenue of $3.5 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Fortune/Merative 11 times total and eight years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally. SLUHN has been named a Top Workplaces 2023 by the Morning Call. In addition, St. Luke’s has been named a Top Workplace nationally, in the Philadelphia region, and in New Jersey. St. Luke’s is the ONLY healthcare institution in Pennsylvania and the third-highest ranked healthcare entity in the nation to be deemed a Top Workplace in 2023. In 2023, St. Luke’s was named one of America’s Best Employers for Women by Forbes. St. Luke’s was the only employer in the Lehigh Valley to be named to the list and was one of only two healthcare employers in Pennsylvania to receive the designation. St. Luke’s University Health Network is the top-ranked Lehigh Valley-based employer in Forbes Magazine’s ranking of employers in Pennsylvania. Learn More Here.