What are the responsibilities and job description for the Pre-Certification Specialist position at Southwoods Health?
– Southwoods Executive Centre
Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians.
Essential Duties:
At Southwoods, it's not just about the treatment, but how you're treated. #SWH
www.southwoodshealth.com
Southwoods Health is hiring a Pre-Certification Specialist to work in our Authorizations Department in Boardman. The Pre-Certification Specialist will request and obtain authorizations for procedures and imaging ordered by Southwoods Health physicians.
Essential Duties:
- Respond promptly to referral source requests for information, supporting documentation, or other report needs
- Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
- Obtain authorization from payer sources to begin services.
- Assist in resolving insurance issues, re-authorization, and eligibility issues
- Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements
- Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed
- Facilitate follow-up regarding ongoing services, eligibility, and authorization
- Communicate payer verification or benefit issues
- Record insurance information to maintain data and communicate insurance information to pertinent staff
- Maintain confidentiality of patient information
- Independently maintain and work from the electronic medical record and additional databases
- Obtain pre-certification number from physician’s office if applicable
- Assist in the development, organization, and maintenance of role specific documents, policies, and tools
- Follow all federal, state, and regulatory guidelines to maintain compliance
- Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies
- Perform other duties as assigned
- Training or courses in business office activities, computer skills, and medical terminology
- Effective communication skills, ability to problem solve, and great attention to detail
- Insurance Verification experience
- Minimum of 2 years’ experience pre-authorizing medical procedure and imaging exams across modality and specialty (FP or IM office experience a plus)
At Southwoods, it's not just about the treatment, but how you're treated. #SWH
www.southwoodshealth.com