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Pre-Certification Coordinator

Mass. Eye and Ear (MEE)

Quincy, MA | Full Time

$79k-121k (estimate)

1 Month Ago

Pre-Certification Coordinator

$79k-121k (estimate)

Full Time 1 Month Ago

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Mass. Eye and Ear (MEE) is Hiring a Remote Pre-Certification Coordinator

Pre-Certification Coordinator

- (3283935)

POSITION SUMMARY:

Responsibilities include contacting insurance plans and/or authorizing agencies to obtain prior approval for scheduled surgical/ancillary events. This individual will be responsible for understanding all payer requirements and supporting the pre-certification/authorization process for all outpatient, surgical and ancillary procedures with the insurance carriers.

ESSENTIAL FUNCTIONS:

1. Work collaboratively and confidentially with support staff as well as other hospital departments, insurance carriers/authorizing agencies to obtain required pre-certification/approval for scheduled procedures.

2. Work collaboratively with health insurance carriers to verify/confirm eligibility. 3. Establish a contact network with the plans/agencies that will enable the pre-certification process to work quickly and efficiently.

4. Record all information related to approvals and denials including but not limited to the approval number, the date of the approval and name of the contact that are communicated to the provider in EPIC.

5. Communicate all pre-certification and/or authorization denials with MEE Financial Counselors and clinical areas.

6. Work closely with the physicians and their support staff to obtain the detailed information required to pre-certify a service. This includes obtaining complete registration, insurance, and the clinical data necessary for completing the pre-certification/authorization process.

7. Collaborate with support staff in situations where insurance carriers require additional clinical information such as peer to peer requests.

8. Work with Primary Care Physicians offices to obtain appropriate referrals and authorizations. Confirm this information with insurance carrier prior to the scheduled date.

9. Maintain strict confidentiality regarding all patient matters. Secure confidential information through the workday.

EDUCATION AND EXPERIENCE:

Minimum of three years’ experience in a health care setting. Current knowledge of CPT/ICD-10-CM coding preferred. Previous experience with pre-certification/approval processes and knowledge on managed care and other health insurance polices helpful. Must possess the ability to communicate and deal effectively with patients, physicians, visitors, and peers in the course of performing job responsibilities.

EEO StatementMassachusetts Eye and Ear is proud to be an equal-opportunity employer and is committed to providing a workplace free from harassment or discrimination. All employment decisions are made without regard to race, color, age, gender, gender identification, sexual orientation, religion, marital status, sex, pregnancy or conditions related to pregnancy, national origin/ancestry, citizenship, disability, military status, genetic information, or any other basis prohibited by law. These protections extend to all management practices and decisions, including recruitment and hiring practices, appraisal systems, promotions, training, and career development programs.

Primary Location MA-Quincy-MEI Mass Eye and Ear Quincy Professional Billing

Work Locations MEI Mass Eye and Ear Quincy Professional Billing 300 Crown Colony Quincy 02169

Job Admin/Clerical/CustService-Other

Organization Mass. Eye and Ear (MEE)

Schedule Full-time

Standard Hours 40

Shift Day Job

Posted Shift Description Full time 40 hours per week Monday- Friday. first 90 days full in office every day. After 90 day probationary period ends eligible to work hybrid schedule 2 days in office and 3 days remote

Employee Status Regular

Recruiting Department MEI Professional Billing

Job Posting Apr 1, 2024

Job Summary

JOB TYPE

Full Time

SALARY

$79k-121k (estimate)

POST DATE

04/27/2023

EXPIRATION DATE

06/01/2024

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The following is the career advancement route for Pre-Certification Coordinator positions, which can be used as a reference in future career path planning. As a Pre-Certification Coordinator, it can be promoted into senior positions as a Member Certification Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Pre-Certification Coordinator. You can explore the career advancement for a Pre-Certification Coordinator below and select your interested title to get hiring information.