What are the responsibilities and job description for the Pre-Certification Specialist position at Phoebe Putney Health System?
Job Number:
30908
Location:
Sumter Campus Bldg 2
Address:
425 West 3rd Ave Ste 410 Albany, Georgia 31701
Department:
PPG SUMTER SURGICAL ASSOC-ADMIN
Shift:
Days (United States of America)
Job Type:
Full time
Posted Date:
2025-01-28
Job Description Summary:
Initiates eligibility verification process for correct plan code on patient hospital record. Ensures pre-authorizations or other reimbursement requirements for treatment are obtained and documented in hospital record prior to date of service. Communicates timely requests for supporting clinical documentation to prevent payment denials. Has a working knowledge of state and federal reimbursement and regulatory requirements. May perform other related duties as assigned.
Description:
Qualifications
High School Diploma or GED (Required)
Work Experience
2 years experience in a health-related environment (hospital or Physician's office) (Required)
Licenses and Certifications
Required Certifications/Licensures:
Certified Healthcare Access Associate (CHAA) within 15 months of hire; previous Certified Patient Account Representative (CPAR) certification acceptable
Essential Functions
DOCUMENTATION:
Documents and submits required information and data in a timely fashion.
Ensures that documentation is tailored to expected readers/users.
Ensure correct plan code has been entered in Meditech
Uses correct terminology.
Conforms to required style and format.
AUTHORIZATION:
Ability to obtain necessary information from insurance companies and completion of correct forms necessary to complete the pre-cert/authorization process.
Ensures pre-cert has been completed.
Knowledge of pre-cert requirements/all payers.
UTILIZATION OF MEDITECH/ATHENA/MOSAIQ:
Ability to understand and utilize systems for medical information look up and documentation.
Log in procedures.
Printing reports.
Quality checklist procedures.
Status procedures.
KNOWLEDGE OF THIRD-PARTY PAYERS:
Ability to understand and follow the policies and practices of insurance companies as it related to pre-cert/authorization.
Determining Eligibility.
Verification of coverage.
Additional Duties
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.
High School Diploma or GED (Required)
Work Experience
2 years experience in a health-related environment (hospital or Physician's office) (Required)
Licenses and Certifications
Required Certifications/Licensures:
Certified Healthcare Access Associate (CHAA) within 15 months of hire; previous Certified Patient Account Representative (CPAR) certification acceptable
Essential Functions
DOCUMENTATION:
Documents and submits required information and data in a timely fashion.
Ensures that documentation is tailored to expected readers/users.
Ensure correct plan code has been entered in Meditech
Uses correct terminology.
Conforms to required style and format.
AUTHORIZATION:
Ability to obtain necessary information from insurance companies and completion of correct forms necessary to complete the pre-cert/authorization process.
Ensures pre-cert has been completed.
Knowledge of pre-cert requirements/all payers.
UTILIZATION OF MEDITECH/ATHENA/MOSAIQ:
Ability to understand and utilize systems for medical information look up and documentation.
Log in procedures.
Printing reports.
Quality checklist procedures.
Status procedures.
KNOWLEDGE OF THIRD-PARTY PAYERS:
Ability to understand and follow the policies and practices of insurance companies as it related to pre-cert/authorization.
Determining Eligibility.
Verification of coverage.
Additional Duties
Adheres to the hospital and departmental attendance and punctuality guidelines.
Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
Performs other duties as required and completes all job functions as per departmental policies and procedures.
Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
Wears protective clothing and equipment as appropriate.
