What are the responsibilities and job description for the Pre-Certification Coordinator position at Mass General Brigham?
Site: Massachusetts Eye and Ear Infirmary
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Budgeted by audiology and approved by VP Ops
Summary
Job Summary
Responsible for reviewing and processing requests for authorization of medical services in accordance with company policies and procedures.
Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
Notifies the appropriate departments of insurance information and obtains and inputs corrected insurance information as needed.
Essential Functions
Work as part of a group to secure insurance authorizations in an appropriate timeframe. Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
Education
High School Diploma or Equivalent required
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
Experience
experience in medical authorization or related field 1-2 years preferred
Knowledge, Skills And Abilities
Additional Job Details (if applicable)
Hybrid
Work Location
300 Crown Colony
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement
Massachusetts Eye and Ear Infirmary is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Budgeted by audiology and approved by VP Ops
Summary
Job Summary
Responsible for reviewing and processing requests for authorization of medical services in accordance with company policies and procedures.
Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
Notifies the appropriate departments of insurance information and obtains and inputs corrected insurance information as needed.
Essential Functions
Work as part of a group to secure insurance authorizations in an appropriate timeframe. Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
- Research and ensure proper and accurate diagnosis and procedure codes are assigned
- Refer patients to financial counseling, as appropriate
- Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues
- Code authorization status in system and complete workflow. Research and remedy denials, while escalating complex denials.
- Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed
Education
High School Diploma or Equivalent required
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
Experience
experience in medical authorization or related field 1-2 years preferred
Knowledge, Skills And Abilities
- Excellent attention to detail and organizational skills.
- Strong communication and interpersonal skills.
- Knowledge of medical terminology and medical insurance benefits, including complete understanding of coordination of benefits.
- Familiarity with computer systems and databases.
- Ability to work independently and as part of a team.
- Ability to work in a fast-paced environment.
Additional Job Details (if applicable)
- Standing Occasionally (3-33%)
- Walking Occasionally (3-33%)
- Sitting Constantly (67-100%)
- Lifting Occasionally (3-33%) 20lbs - 35lbs
- Carrying Occasionally (3-33%) 20lbs - 35lbs
- Pushing Rarely (Less than 2%)
- Pulling Rarely (Less than 2%)
- Climbing Rarely (Less than 2%)
- Balancing Occasionally (3-33%)
- Stooping Occasionally (3-33%)
- Kneeling Rarely (Less than 2%)
- Crouching Rarely (Less than 2%)
- Crawling Rarely (Less than 2%)
- Reaching Occasionally (3-33%)
- Gross Manipulation (Handling) Constantly (67-100%)
- Fine Manipulation (Fingering) Frequently (34-66%)
- Feeling Constantly (67-100%)
- Foot Use Rarely (Less than 2%)
- Vision - Far Constantly (67-100%)
- Vision - Near Constantly (67-100%)
- Talking Constantly (67-100%)
- Hearing Constantly (67-100%)
Hybrid
Work Location
300 Crown Colony
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement
Massachusetts Eye and Ear Infirmary is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
