What are the responsibilities and job description for the Pre-Certification Specialist position at Insight?
WE ARE INSIGHT:
At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now!General Summary:
The Pre-Certification Specialist is responsible for processing referrals for services and obtaining needed authorizations from the patient’s payor source. This is to be done for both out-patient testing, out-patient surgeries and inpatient stays. A Pre-Certification Specialist is responsible for collecting all information needed, to properly notify and obtain authorizations from all of the patient’s payor sources and be able to effectively communicate.
These duties are to be performed in a highly confidential manner, in accordance with the mission, values and behaviors of Mercy Hospital and Medical Center. Employees are further expected to provide a high quality of care, service, and kindness toward all patients, staff, physicians, volunteers and guests.
Duties and Responsibilities:
- Contacts insurance companies and other payors to notify of admissions
- Obtains and clarifies procedural and diagnosis information form physician
- Identifies correct insurance plan and contacts the patient to determine if secondary insurance coverage exists.
- Receives and processes requests for internal transfers for confirmation of patient benefits and notification of patient status change
- Verifies insurance coverage and benefits for patient admissions either electronically or via other media
- Makes written and/or verbal inquiries to third party payers to verify insurance status and obtain pre-certification
- Refers patients to financial counselors to assist with payment for services
- Creates patient pre-registration accounts in the electronic system to allow for the addition of notes to an account
- Keep orderly files of information that is gathered
- Distribute information to appropriate departments to expedite patient care
- Performs various clerical tasks to expedite the verification process, including documentation of guarantor information, patient information and protocols
- Analyze reports to determine changes in patient types
- Perform other duties as assigned
- Reviews and monitors pending pre-certification cases daily, ensuring timely follow-up with payers
- Assists with compiling weekly/monthly metrics (e.g., turnaround times, pending volumes, denial reasons
Required Knowledge, Skills, and Abilities:
- High School Diploma required
- Must have 2 years of college in general business field or technical school related to medical field or a experience equivalent to the above
- Must have previous customer service experience or education
- Ability to provide excellent customer service at all times
- Ability to multi-task
- Understands medical terminology
- Understands insurance terminology
- Understands Medicare, Medicaid, and commercial insurance
- Previous experience with data entry computer system
- Ability to organized an systematic
Benefits:
- Paid Sick Time - effective 90 days after employment
- Paid Vacation Time - effective 90 days after employment
- Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month
- Short and long-term disability and basic life insurance - after 30 days of employment
Disclaimer:
The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of functions, tasks, duties, responsibilities and requirements of employees so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of Insight Hospital and Medical Center.
Insight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs.
Insight is an equal opportunity employer and values workplace diversity!