Pre-Certification Coordinator - Specialty - MEE
Pre-Certification Coordinator - Specialty - MEE
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Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
SummaryResponsible for reviewing and processing requests for authorization of medical services in accordance with company policies and procedures. Collects and accurately enters information required by third parties for precertification for procedures tests and imaging. Notifies the appropriate departments of insurance information and obtains and inputs corrected insurance information as needed.
Does this position require Patient Care
No
Essential Functions
-Work as part of a group to secure insurance authorizations in an appropriate timeframe. Collects and accurately enters information required by third parties for precertification for procedures tests and imaging.
-Research and ensure proper and accurate diagnosis and procedure codes are assigned
-Refer patients to financial counseling as appropriate
-Inform patient of authorization concerns prior to admission/procedure coordinating with appropriate parties to facilitate authorization as appropriate collaborating with other departments/offices to resolve complex authorization issues
-Code authorization status in system and complete workflow. Research and remedy denials while escalating complex denials.
-Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed
Qualifications
Education
High School Diploma or Equivalent required
Can this role accept experience in lieu of a degree
No
Licenses and Credentials
Experience
experience in medical authorization or related field 1-2 years preferred
Knowledge Skills and Abilities
- Excellent attention to detail and organizational skills.
- Strong communication and interpersonal skills.
- Knowledge of medical terminology and medical insurance benefits including complete understanding of coordination of benefits.
- Familiarity with computer systems and databases.
- Ability to work independently and as part of a team.
- Ability to work in a fast-paced environment.
Additional Job Details (if applicable)
Physical Requirements
- Standing Occasionally (3-33%)
- Walking Occasionally (3-33%)
- Sitting Constantly (67-100%)
- Lifting Occasionally (3-33%) 20lbs - 35lbs
- Carrying Occasionally (3-33%) 20lbs - 35lbs
- Pushing Rarely (Less than 2%)
- Pulling Rarely (Less than 2%)
- Climbing Rarely (Less than 2%)
- Balancing Occasionally (3-33%)
- Stooping Occasionally (3-33%)
- Kneeling Rarely (Less than 2%)
- Crouching Rarely (Less than 2%)
- Crawling Rarely (Less than 2%)
- Reaching Occasionally (3-33%)
- Gross Manipulation (Handling) Constantly (67-100%)
- Fine Manipulation (Fingering) Frequently (34-66%)
- Feeling Constantly (67-100%)
- Foot Use Rarely (Less than 2%)
- Vision - Far Constantly (67-100%)
- Vision - Near Constantly (67-100%)
- Talking Constantly (67-100%)
- Hearing Constantly (67-100%)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
IC
Employment Type
Full-Time
