Pre Certification Specialist

Advocate Health And Hospitals Corporation

Job Location:

Libertyville, IL - USA

Monthly Salary: $ 21 - 32

Posted on: 10 hours ago

Vacancies: 1 Vacancy

Job Summary

Department:

37393 Advocate Illinois Masonic Medical Center - Infusion: Libertyville

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

Schedule Details/Additional Information:

Monday - Friday 8:30a-5:00p; No weekends or major holidays

Pay Range

$21.85 - $32.80

Major Responsibilities:

To perform all activities related to third-party payer pre-certification requirements to meet the daily pre-certification functions at Dreyer Medical Clinic.
Completes pre-certification process or transfers call as appropriate.
Upon completion of the pre-certification process enters authorization number in the order and closes encounter.
Monitors all Peer-to-Peer pre-certification decisions forwarded by RN Nurse Specialist and closes case with appropriate determination from pre-certifcation vendor.
Verifies per insurance type and service requested the need for pre-certification. Notifies the Business Office when patients with No Insurance or Termed Insurance are identified.
Reviews pended order for completeness and accurate coding.
Contacts the pre-certification vendor and provides the facility and patient demographic information.
Monitor future orders and assure completion of pre-certification process by due date of procedure.
Identifies orders placed outside the number of days determined valid by the pre-certification vendor and postpones those orders in EPIC using postpone function or staff message function.
Serves as an advocate and liaison between patients associates physicians and external customers by sharing necessary information to ensure continuity of care.
Completes all patient documentation within the defined time frame and cnsistently completes pre-certification with all appropriate information

To serve as a resource to Clinic Associates on Pre-certification specific issues

Provide technical support to associates seaders and providers
Orient new associates to pre-certification functions in EPIC and other vendor specific applications
Provide education to associates leaders and providers on Dreyer Medical Clinic pre-certifications procedures and protocols
Actively participates in special programs and activities designed to address needs of high-end advanced imaging pre-certification processes and acts as resource for the Clinic

Appointment Scheduling

Make outgoing calls to patients to return to the clinic for additional views confirm appointments and preparations and reschedule no showed and canceled appointments.
Execute patient scheduling duties and document within the EPIC/IDX system(s) following provider specifics and scheduling guidelines.
Collect necessary information from patient when scheduling and/or cancelling appointments and documents/updates information in EPIC/IDX system(s).
Instruct patients on necessary preparations when booking appointments/testing using appropriate language to patients level of understanding guided by department protocols or technologist/provider/nurse instructions.
All communications with callers internal and external are conducted in accordance with department protocol utilizing clinic scripting where indicated.
Schedules future appointments in multiple modalities and locations for Radiology both automatically and manually.

Telephone Communication

Answers the telephone promptly within 3 rings.
Utilizes outlined departmental and clinic scripting/key words.
Restates information to ensure clarity and accuracy.
Transfers calls when appropriate staying on the line and announcing where and why call was transferred. Exceptions to announcing the call would include when transferring to an ACD complete and accurate communication with internal and external customers

Other Duties as assigned

Attend department meetings and clinic training.
Maintain tracking of pre-certification activities as assigned.
All required clinic education via ALEX.
Special projects as assigned by direct supervisor.

Education/Experience Required:

High school diploma or GED
2 years experience in a medical office setting performing related duties/functions.

Knowledge Skills & Abilities Required:

Professional communication and interpersonal skills.
CRT/PC experience in a customer service setting.
Ability to type with good accuracy.
Familiar with MS Word Excel and Outlook.
Ability to solve problems posed by callers seeking pre-certification authorizations
Proven ability to handle difficult callers customers and/or patients.
Knowledge of medical terminology and ICD-9 HCPCS CPT coding.

Physical Requirements and Working Conditions:

Must be able to successfully complete clinic-based training for all associates.
Ability to work with all levels of personnel.
Ability to work under stressful situations.
Frequent periods of extended sitting.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs competitive compensation generous retirement offerings programs that invest in your career development and so much more so you can live fully at and away from work including:

Compensation

Base compensation listed within the listed pay range based on factors such as qualifications skills relevant experience and/or training
Premium pay such as shift on call and more based on a teammates job
Incentive pay for select positions
Opportunity for annual increases based on performance

Benefits and more

Paid Time Off programs
Health and welfare benefits such as medical dental vision life andShort- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit integrated health system in the United States created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas Georgia and Alabama; and Aurora Health Care in Wisconsin Advocate Health is a national leader in clinical innovation health outcomes consumer experience and value-based care. Headquartered in Charlotte North Carolina Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology neurosciences oncology pediatrics and rehabilitation as well as organ transplants burn treatments and specialized musculoskeletal programs. Advocate Health employs 155000 teammates across 69 hospitals and over 1000 care locations and offers one of the nations largest graduate medical education programs with over 2000 residents and fellows across more than 200 programs. Committed to providing equitable care for all Advocate Health provides more than $6 billion in annual community benefits.

Required Experience:

Department:37393 Advocate Illinois Masonic Medical Center - Infusion: LibertyvilleStatus: Full timeBenefits Eligible:YesHours Per Week:40Schedule Details/Additional Information:Monday - Friday 8:30a-5:00p; No weekends or major holidaysPay Range$21.85 - $32.80Major Responsibilities:To perform all act...