Pre-Certification Specialist , Imaging

Overview

Pre-Certification Specialist I, Imaging (Maintenance)

JOB SUMMARY:

The Pre-Certification Specialist I (Imaging) provides specialized assistance to patients and clinical staff using knowledge of pre-certification requirements of insurance plans and delivers excellent patient service.

• Verify all demographic and insurance information on patients, including co-pays, deductibles, stop losses, guarantors, subscribers, precertification requirements, and in-patient requirements. Update demographic and insurance information in a timely fashion.
• Obtain and review physician orders for medical necessity coverage requirements.
• Research coverage criteria with insurance companies, medical literature, and compendiums to determine eligibility for services in a timely manner. Utilize multiple healthcare websites. Run computer-generated reports for appointment schedules.
• Communicate eligibility issues with all designated personnel in a timely fashion.
• Other duties as assigned.

High school graduate or equivalent

• Minimum of two years experience working in healthcare insurance or medical clinic
• Working knowledge of managed care, medical terminology, pre-cert process and insurance claims processing
• Working knowledge of ICD-10, CPT, and HCPCS coding preferred
• Ability to handle high patient volumes
• Excellent problem solving skills and be extremely detail oriented
• Excellent computer and other basic office equipment skills

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

Must interact and communicate both verbally and in written form. Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hands to finger, handle or feel objects, tools, or controls;

and reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.

The work environment described here is representative of those an employee encounters while performing the essential functions of this job. This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.