Pre-Certification Representative II Medical Group Neurology

Hourly Pay Range:

Position Highlights:

Position: Pre-Certification Rep II

Location: Glenview IL

Full Time/Part Time: Full time (40 hours per week)

Hours: Monday to Friday 8:30AM-5:00PM

Position Summary:

Under the management of the Practice Manager for General Neurology/Headache 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 ensure 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 Botox injections.

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 and Practice Manager 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.

At Endeavor Health we are united by a shared commitment to working together to create a culture of connection and belongingeach of us bringing different skills and experiences as we deliver safe seamless and personal care. Every person every time. We are committed to fostering an environment where all team members can be their best learn and pursue excellence together.

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