POSITION SUMMARY: The Pre-Certification Coordinator is responsible to coordinate and support the Pre-Certification Department with authorizations on Managed Care referrals and admissions. Functions include but not limited to confirming and documenting details approvals, initiating notifications or pending reference numbers on new referrals, triaging and responding to requests from internal/external customers with end goal increase Managed Care census and maximize revenue. Therefore, the Pre-Cert Coordinator must have a working knowledge of the nursing centers, managed care contracts, and insurance companies. Staff will ensure immediate response to all inquiries and support department to streamline efficiencies with workflow.
RESPONSIBILITIES/ACCOUNTABILITIES:
1. Prioritize workload using the IRM Worklists for Confirmation and Obtain authorizations.
2. Provide support by verifying and documenting details on authorizations obtained by field through phone and electronic methods.
3. Initiate notifications to create pending reference numbers on new referrals via managed care companies online portals or telephonically.
4. Utilize Insurance Reference Cards to identify of rates and exclusions and to complete Pre- Authorization User Defined Assessments in IRM. Dependent on exclusion billing arrangement, utilize pharmacy application, Omniview, to price costs, review medication list post admission, and submit vendor billing notifications when applicable.
5. Support monthly pharmacy review process to identify and code both Genesis and Vendor billed medication exclusions according to current procedures.
6. Provide assistance to clinician which can include obtaining additional documentation from Clinical Admission Director, assisting with managed care plan required pre-authorization forms, securing documentation from electronic referral sources such as Allscripts or CuraSpan, and submission materials to health plans via e-fax or portal upload.
7. Meet and/or exceed established benchmarks of pre-auth cases per day as determined by the
Supervisor/Director.
8. Maintain a positive working relationship with all referral sources, managed care companies and internal customers to include Admission Directors, Clinical Admission Directors, Regional Directors of Business Development, Internal Case Managers, etc;
9. Assist the Supervisor/Director to assure efficiencies in workflow and maximization of managed care census and revenue.
10. Performs other related duties as assigned.
CPCT
Qualifications:
SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Undergraduate degree in Business or health related field or equivalent work related experience. Background in Skilled Nursing Center admissions preferred.2. Three to five years or more of diversified health care experience.3. Must be familiar with insurance coverage, contract requirements, and third party reimbursement.Ideally, direct experience with benefit verification, referrals/authorizations, billing/collections, and/or utilization review/discharge planning.4. Motivated individual with strong technical and communication skills, written and oral, as well as customer service.5. Demonstrated proficiency in word processing and spreadsheet software preferred. Other Info
Position Type: Full Time
Job City: Kennett Square
Requisition Number: 441152
Not Stated