PRECERTIFICATION SPECIALIST

Job Description Summary

Under the direction of the Manager of Patient Access Services. Responsible for all pre-certification,eligibility , verification of benefits and collection of eligible co-pays

Job Description

Essential Functions

1. Responsible for registration, pre-certification, eligibility , verification of benefits and co-pay determination on all accounts

a. Insures that account is processed with less than 5 denials per year.

b. Determination of copay and notify patient and arrange for collection

c. Complies with all regulatory agencies.( newborn notification) 100% of the time

d. Keeps current with all internal and external policies and procedures which may affect reimbursement.

e. Ability to write and follow up on appeals for denials.

f. Ability to give patients estimate for self-pay and non-covered services.

g. Document clearly on account all actions and transactions

h. Able to collaborate with case management for patient care

i. Able to defer elective cases based on credit and collections policy

j. Manage level of care changes to ensure proper reimbursement

2. Technology – Embraces technological solutions to work processes and practices.

a. Able to function using department computer programs. Meditech,PICIS,PAssport and web based programs, and run reports.

b. Able to use and update PICIS, Tracker and Passport programs.

c. Manage own API(timecard) system.

d. Able to utilize the telephone system,including VERA

e. Understands process for computer downtime

f. Understands and promotes credit and collection policy

g. Able to assign and trascribe ICD-9 and CPT codes

h. Manage and utilize insurance web sites to ensure appropriate notification and referrals are done


3. .Safety Awareness – Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.

a. Adheres to patient identification policies/procedures.

b. Adheres to universal precautions and respiratory etiquette guidelines.

c. Understands individual role/responsibility during hospital codes(e.g. Code Green, Code red).

d. Do safety rounds

e. NIMS 100 completed

f. Understand role in department specific plan for emergency preparedness

g. Able to identify correct subscriber


Essential Functions (Cont.)

I. Technology and Learning

a. Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.

b. Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

Unit Department Specific Job Functions

Unit Specific functions are those tasks, duties and responsibilities that are specific to the performance of the job within a certain unit(s). Following are unit specific functions of the job, along with the corresponding performance standards.

1. Can register patients meeting the department standard of 98% accuracy rate.

Non-Essential Functions

Non-essential functions are those tasks, duties and responsibilities that are not critical to the performance of the job. Following are non-essential functions of the job, along with the corresponding performance standards.

1. Other duties as required.

Medical terminology. Insurance Knowledge Computer skills Strong knowledge of third party insurance required Ability to follow through and troubleshoot Attention to detail Customer Service skills Organizational skills Ability to work well within a team.