Pre Certification Specialist - Imaging

Pre Certification Specialist - Imaging

Southwoods Health is hiring a Pre Certification Specialist to work at Southwoods Imaging in Boardman, Ohio. Will work with referring physician offices to obtain insurance pre-certification from various insurance companies for procedures ordered at Southwoods Imaging.

Essential Duties :

• Respond promptly to referral source requests for information, supporting documentation, or other report needs
• Obtain accurate and detailed information to begin investigating sources for payment and gather patient information
• Obtain authorization from payer sources to begin services
• Answer and screen telephone referrals
• Assist in resolving insurance issues, re-authorization and eligibility issues
• Verify eligibility with all insurance carriers
• Facilitate follow-up regarding ongoing services, eligibility and authorization
• Communicate payer verification or benefit issues
• Maintain confidentiality of patient information
• Verify all commercial insurance coverage, workers' compensation insurance, accident insurance, and state programs and determine patient's responsibility if applicable
• Obtain pre-certification number from physician's office if applicable
• Determine patient qualification for coverage by third-party payer and inform financial counselor, patient, or family member of status
• Maintain current list of facility insurance contracts
• Document pre-qualification for third-party payer before date of scheduled procedure
• Maintain current information on correct and lawful practices for billing government and private payers for imaging procedures
• Follow all federal, state, and regulatory guidelines to maintain compliance
• Ensure all processes at responsible physician practice maintains compliance with all regulatory agencies
• Perform other duties as assigned

Qualifications :

Full-time. Monday-Friday dayshift.

At Southwoods, it's not just about the treatment, but how you're treated. #SWH

www.southwoodshealth.com