Precert Coord Outpatient
Precert Coord Outpatient
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Job Description
Overview
Outpatient Pre-Certification Coordinator Admitting & Registration
Full Time 80 hours per pay period Day shift
Parkwest Overview:
Headquartered in Knoxville Covenant Health is a community-owned integrated healthcare delivery system and the areas largest employer.
Parkwest is Covenant Healths and West Knoxvilles premier medical facility and a top-performing heart hospital offering our patients world-class treatment with all the convenience and warmth of home.
In addition to providing the areas leading cardiac services Parkwest has been nationally recognized for award-winning care throughout our facility. For 2020-21 Parkwest received recognition fromU.S. News & World Reportas one of the Top 10 hospitals in Tennessee.
Knoxville located inEast Tennesseeis the third largest in the state well-known for itsproximity to the Great Smoky Mountains National Parkand is the home of the University of Tennessee.Go Vols! Living in Knoxville means experiencing all four seasons. Best of all each of them is pretty mild!
Combine all that with the abundant natural beauty of the surrounding mountains and you have a city that truly offers something for everyone. Knoxville has a vibrant arts culture seasonal festivals top-notch foodie and incredible outdoor recreation. Its a perfect blend of big-city amenities and Southern charm
Admitting & Registration :
Our friendly and courteous registration staff is here to serve the patients registration needs whether the patient is here for a simple lab test diagnostic testing surgery or inpatient services. Registration Specialists are most often the patients first contact. They are responsible for obtaining patient demographics validate the patients identification and verify insurance benefits. Our staff collects financial information so we may accurately bill the patient or their insurance for services rendered. The Registration Department has three areas which are Emergency Department Registration Outpatient Registration and Pre-registration/Insurance Verification.
- Outpatient Registration is located in the Main Lobby of the hospital. Hours of operation are: Monday Friday: 5 a.m. -7:30 p.m. and Saturday: 6:30 a.m. 3 p.m. The staff in Outpatient Registration work 8 hour shifts. For the patients convenience there is also a Financial Counselor located in Outpatient Registration for patients to come in to discuss their account and make payments. Office hours are 8 a.m. 4:30 p.m.
- ED Registration is open 24 hours per day 7 days a week. The staff in the ED Registration work 10 hour shifts. They also rotate weekends.
- The Pre-Registration/Insurance Verification office is located on the main level of the hospital behind Outpatient Registration. Hours of operation are: 6:30 a.m. 5:30 p.m.
Our staff receive on-going training for the 11 different systems that are currently being used. We are always looking for improvement from our patients and employee feedback. Our vision is to strive for excellence in quality efficiency and provide the highest customer service for all patients.
Position Summary:
Assures payment from outpatients third party insurer by meeting all precertification requirements and by verification of patients insurance coverage. Establishes controls so that patients understand and receive accurate information on their patient liability.
Recruiter: Kathleen Rice
Responsibilities
- Precertifies outpatient services in compliance with regulatory/insurance requirements.
- Verifies with insurance company the nature and extent of patients insurance coverage.
- Follows-up on all claim denials for outpatient services. Determines the cause of denial aggressively challenges wrongful denials and works with appropriate parties on resolutions.
- Assists off-site providers with procedural issues related to proper pre-certification and insurance verification requirements. Provides training to these locations as regulations/insurance requirement change and as employee turnover occurs.
- Participates with clinical financial and utilization review departments to address opportunities to improve overall collections and cash flow.
- Responsible for automation requests that will enhance efficient collection of monies due the hospital. Able to develop format layout for programming needs.
- Analyzes data for opportunities to achieve improved collections enhance relations with insurance companies and physician practices and improve workflow related to outpatients.
- Follows policies procedures and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge skill and ability needed to perform the essential tasks of the job typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.
Minimum Experience:
Experience in outpatient registration. Will consider LPN with two years experience or individuals with inpatient pre-certification and insurance verification experience.
Licensure Requirement:
None
Employment Type
Full-Time
