Pre-Certification Rep II

Hourly Pay Range:

Position Highlights:

• Position: Pre-Certification Rep II
• Location: Skokie IL
• Full Time/Part Time: Full time
• Hours: Monday-Friday standard business hours 8:30am-5pm

Position Summary:

Under the management of the Manager Patient Access the Pre-Certification Representative II is responsible to initiate and manage referrals / pre-authorization / pre-certification based on clinical orders for an assigned patient addition the Pre-Certification Representative II is responsible to determine insurance eligibility and as appropriate benefits and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative II provides these services to ensure that our customers are provided a high quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative II helps to insure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized.

What you will do:

• Submits referral and / or pre-certification requests for physician visits diagnostic testing procedures durable medical equipment home care and all other medical care services per individual carrier procedures.
• Communicates and coordinates with office or physician if payer specific additional clinical information of physician peer to peer is necessary to successfully process the referral or pre-certification.
• Communicates negative payer determinations (denied authorizations) to ordering physician / department to facilitate decision making in clinical next steps.
• Communicates third party payer decision on authorization / pre-certification to patient. This includes communication and education of patient regarding patient specific insurance carrier requirements and possible out of pocket patient responsibility.
• Documents outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals denials status outcomes etc.
• Consistently follows prescribed workflows standards and protocols for managing and obtaining referrals authorizations and priorities.

What you will need:

• Education: High School Diploma
• Experience: 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation processing and coordination strongly preferred.

Benefits (For full time or part time positions):

• Career Pathways to Promote Professional Growth and Development
• Various Medical Dental Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality vibrant community-connected care serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25000 team members and more than 6000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals Edward (Naperville) Elmhurst Evanston Glenbrook (Glenview) Highland Park Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) all recognized as Magnet hospitals for nursing excellence. For more information visit .

When you work for Endeavor Health you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website () to better understand how Endeavor Health delivers on its mission to help everyone in our communities be their best.

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity equity and inclusion is at the core of who we are; being there for our patients and each other with compassion respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets VEVRRA Federal Contractor.