ASC Precertification Specialist - SouthPark

Primary Objective

Responsible for the verification of insurance benefits and obtaining prior authorizations for all incoming SPSC ambulatory surgeries by successfully performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates.

Essential Functions

• Prioritize incoming authorization requests according to urgency as well as CEENTAs EPIC Workqueues.
• Respond to clinic questions regarding payer medical policy guidelines.
• Verify insurance eligibility and obtain authorization via payer website or by phone and document all authorization information in media manager as well as make necessary corrections in the EPIC Systems.
• Document patient responsibility in the EPIC System based off information retrieved from the insurance payors while preauthorizing services for physicians facilities and anesthesia practices.
• Communicate detailed policy benefits to patients medical offices and financial counselor teams as well as document information in EPIC system.
• Maintain Professional and Positive communication skills internally and externally.
• Maintain individual patient files to include up to date information pertaining to authorizations.
• Ability to meet the physical and mental demands of the position.
• The ability to work onsite.
• Predictable reliable and prompt attendance.

Skills and Abilities

• Extensive knowledge and understanding of insurance payors medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
• Knowledge of medical terminology data entry hospital and/or Medical Group practice operations.
• Knowledge of the precertification and authorization process and its direct impact on the practices revenue cycle.
• Ability to communicate to clinical departments and/or physician practices changes to the preauthorization processes based on payor guidelines including HIPPA procedures and policies.

Mathematical Skills:

Ability to add subtract multiply and divide in all units of measure using whole numbers common fractions and decimals ability to apply compute rates and percent as needed to generate patient estimate of cost forms as well as insurance allowable deductibles copayments and coinsurances.

Reasoning Ability:

• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.
• Ability to multitask and remain focused while managing a highvolume timesensitive workload

Core Competencies

• Patient Focus
• Attention to Detail
• Information Collection & Management
• Mathematical Reasoning
• MultiTasking & Adaptability
• Working with Tools and Technology
• Personal & Professional Ethics

Clinical Competencies

N/A

Accountability

Our mission is to be the premier eye ear nose and throat group providing comprehensive quality and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates P.A.

The ASC Precertification Specialist is responsible for the verification of insurance benefits and obtaining prior authorizations for all procedural orders by successfully performing duties within the scope of the policy and procedures defined by Charlotte Eye Ear Nose and Throat Associates to ensure timely reimbursement for all services rendered in the Ambulatory Service Center.

Supervisory Responsibilities

The ASC Precertification Specialist reports to the ASC Business Office Manager. This position has no supervisory responsibilities.

Education

High school diploma or equivalent combination of education and experience.

Experience

• Minimum of two 2 years of relevant work experience in a medical prior authorization role.
• Minimum of one 1 year experience using the EPIC practice management software.

Certificates Licenses Registrations

N/A

Training Period

Employee must be able to successfully complete all job responsibilities after 60 days of onthejob training. Additional EPIC training will be provided from CEENTA and Novant in the following areas:

• EPIC Patient Registration Training
• Epic Precertification Training
• EPIC Health Information Systems Training

Work Environment

The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The ASC Precertification Specialist position is located within a shared office within SouthPark Surgery Center.

Employee must be comfortable operating in a collaborative shared leadership environment the noise level in the work environment is usually quiet.

Employee will utilize two computer systems as well as telephone copier machine and fax machine to complete job responsibilities.

Position Type and Expected Hours of Work

Fulltime position within the following hours:

• 7:30 am to 4:00 pm

Physical and Mental Requirements

The physical and mental demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Position requires employee to sit in the front of a computer for long hours typing repetitive clicking of a mouse.
• Position requires extensive telephone usage.
• Ability to problem solve to work under pressure make quick decisions as well as work well independently and with a team to reach departmental goals and the ability to interpret data.

Other Requirements:

• Active & Current Drivers license
• Clean driving record
• Consistent and Reliable Transportation
• Polite and professional disposition

Travel

Travel is not required for this position.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee for this job. In addition to those essential functions identified above individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice.

A Typical Day in the Position

Daily Precertification Processes:

• Respond to Scheduler emails or telephone calls requesting good faith estimates for unscheduled patient procedures obtain the patients MRN and the procedure codes from scheduler and draft an estimate for the scheduler to provide to the patient.
• Open Workqueue list in CEENTA EPIC and print assigned referrals in date order.
• Verify insurance coverage and precertification or predetermination requirements for specific procedure codes either online or by calling insurance company if by telephone make sure to get a call reference number for future tracking purposes. If by website or email upload copy of proof into EPIC Media Manager for every case.
• Determine benefits (deductible/coinsurance/OOP max) and enter benefits in benefit collection section and enter patients responsibility and expected payment amounts in the prepayment section of the patients account.
• If any complications or issues arise from the precert request (ex. timing issues not enough clinicals missing CT reports etc... contact schedulers and technicians to obtain the proper information to provide to the insurance company for approval.
• If case does need approval mark it as pending with a note awaiting approval and place in a pending folder.
• Once approval is received from insurance company mark the case as complete/authorization received document the authorization number as well as the date range of the authorization/approval along with all pertinent information regarding care.
• File the referral with the completed cases in date order.
• Review Novant Workqueue by comparing CEENTA referral information to the Novant EPIC system and make sure the data in the patients Novant account mirrors the information in the patients CEENTA account.
• Also mark the Novant account as approved or approval not needed with the authorization number procedure codes and authorization range dates so the referral will be marked complete and drop off the Novant Workqueue.