Precertification Specialist - Nucleus Bldg First Shift
Precertification Specialist - Nucleus Bldg First Shift
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Job Description
Overview
WE ARE HIRING!
Location: Nucleus Building 300 E Market St. Louisville
Shift: First Fulltime
About UofL Health
UofL Health is a notforprofit 501(c)3fully integrated regional academic health system with nine hospitals four medical centers Brown Cancer Center Eye Institute more than 250 physician practice locations and more than 1200 providers in Louisville and the surrounding counties including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.
Affiliated with the University of Louisville School of Medicine UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials collaboration on research and the development of new technologies to both save and improve lives. With more than 14000 team members physicians surgeons nurses pharmacists and other highlyskilled health careprofessionals UofL Health is focused on one mission: to transform the health of communities we serve through compassionate innovative patientcentered care.For more information on UofL Health go to .
Our Mission
As an academic health care system we will transform the health of the communities we serve through compassionate innovative patientcentered care.
Job Summary:
The Precertification Specialist sets the precedence to ensure a positive patient experience for upcoming surgical procedures and diagnostic tests by accurately and efficiently completing all necessary steps related to prior authorization medical necessity determination and financial clearance for the hospital system and physician services for clinics adult acute facilities and diagnostic centers.
Responsibilities
- Accurately and efficiently identifies all appropriate and necessary clinical documentation to support medical necessity for all scheduled procedures/medication orders for multiple service lines and clinics.
- Submits authorizations and clinical information to the appropriate payer/benefit manager in a timely fashion in compliance with plan rules including appropriately utilizing the CMS IP Only list.
- Assesses orders to determine appropriate patient class and works with physicians to clarify as necessary
- Contacts insurance plan/payers to determine eligibility coverage information for specific procedures and benefit information
- Coordinates patient encounters using multiple systems applications various registration applications clinical operating systems eligibility verification systems and medical necessity applications.
- Documents all findings/communications thoroughly and accurately in the patient record.
- Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
- Documents all authorization information accurately in the referral as necessary to produce a clean transaction with the payer.
- Answer and responds to all communications through multiple applications in a timely and professional manner to ensure a positive patient experience.
- Complies with all departmental and organizational policies and procedures.
- Complies with local state and federal rules and regulations and the requirements of accrediting bodies.
- Prioritizes work according to the department hospital and patient needs.
- Independently works to resolve patient and provider questions related to prior authorizations referrals and insurance verification.
- Acts as a liaison between the patient payer provider and clinical support staff.
- Responsible for managing/setting up peer to peers and/or appeals for providers in a timely and professional manner according to individual plan guidelines.
- Work with all necessary parties to ensure patients are rescheduled/ notified of denials promptly.
- Responsible for understanding and staying current and up to date on payer regulations.
- Accurately provide expected timeframes /payer guidelines to patients and providers regarding prior authorization/ financial clearance.
- Maintains compliance with all company policies procedures and standards of conduct
- Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
Performs other duties as assigned
Qualifications
Education:
- High School Diploma or equivalent (required)
Experience:
- At least one year of patient access insurance verification prior authorization or related experience (required)
- 3 years of prior authorization or related experience (preferred)
- Medical Terminology preferred
Required Experience:
Unclear Seniority
Employment Type
Unclear
