Precertification Representative

Overview

Works as part of the Patient Access team to initiate precertification and / or verify precertification information. Enters precertification information in the registration system. Coordinates with patients, physicians, physician office staff, and other hospital employees to ensure all necessary pre-certifications are obtained and documented. Maintains a high level of accuracy and completes all tasks within designated timeframes.

Responsibilities

Key Responsibilities / Essential Functions

Accurately identifies patient records using 2 patient identifiers.

Verifies insurance eligibility and precertification requirements.

Initiates and / or verifies precert information for all applicable visits.

Coordinates with physician office staff to obtain all clinical codes necessary for precertification.

Accurately enters medical, insurance, and precertification data into the registration system.

Notifies Patient Access staff of precertification issues in a timely manner.

Performs all functions with minimal supervision or guidance.

Provides excellent customer service and service recovery when needed.

Prioritizes multiple simultaneous customer / physician / staff requests.

Required to attend departmental staff meetings.

Successfully completes all mandatory training.

Responsible for managing personal time and attendance, notifying supervisor immediately of issues.

Responsible for knowledge of all pertinent policies and procedures.

Must utilize AIDET and HEATT to problem solve with patients, visitors, co-workers and staff from other departments.

Qualifications

Minimum Knowledge, Skills, Experience Required

Education/Certification:  High School/GED required.  Post-secondary education preferred.

Experience: Physician office / precertification experience preferred. Two years customer service experience preferred.  Previous registration, scheduling, insurance, medical records, or billing experience strongly preferred.

Additional Skills/Abilities

      Excellent verbal and written skills required. Must possess ability to work in a fast-paced environment with a positive attitude.  Must demonstrate effective time management skills.  Must demonstrate efficiency and organizational skills with the ability         to multitask.  

Proficiency in Microsoft Office Suite strongly preferred.