Precertification Specialist

Description

Position Summary:

Responsible for obtaining pre-certifications and pre-authorizations for hospital service lines per assigned caseload by successfully completing the required authorization process in addition to effectively communicating details to appropriate departments.

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

• Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
• Request, track and obtain pre-authorization from insurance carriers within time allotted for assigned workload and follow up on regularly pending cases.
• Ensure tracking programs and patient records are kept up to date through the pre-certification process.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general inpatient hospital understanding including HIPAA regulations.
• Clearly document all communication and contacts with providers and personnel in standardized documentation requirements.
• Communicate any insurance changes or trends among team.
• Prioritize authorization requests according to urgency.
• Answer insurance telephone inquiries pertaining to patient accounts.
• Perform other duties as required.

Safety (15% of performance review)

• Strives to create a safe, healing environment for patients and family members
• Follows all safety rules while on the job.
• Reports “near misses”, as well as errors and accidents promptly.
• Corrects minor safety hazards.
• Communicates with peers and management regarding any hazards identified in the workplace.
• Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
• Participates in quality projects, as assigned, and supports quality initiatives.
• Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

• Works well with others in a spirit of teamwork and cooperation.
• Responds willingly to colleagues and serves as an active part of the hospital team.
• Builds collaborative relationships with patients, families, staff, and physicians.
• The ability to retrieve, communicate, and present data and information both verbally and in writing as required
• Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
• Demonstrates adequate skills in all forms of communication.
• Adheres to the Standards of Behavior

Integrity (15% of performance review)

• Strives to always do the right thing for the patient, coworkers, and the hospital
• Adheres to established standards, policies, procedures, protocols, and laws.
• Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
• Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
• Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
• Exemplifies professionalism through good attendance and positive attitude, at all times.
• Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
• Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

• Demonstrates accountability for ensuring the highest quality patient care for patients.
• Willingness to be accepting of those in need, and to extend a helping hand
• Desire to go above and beyond for others
• Understanding and accepting of cultural diversity and differences

Qualifications

Education

• Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.
• Preferred: Associates or Bachelors degree.
• Maintains education and development appropriate for position.
• May substitute experience for education

Experience

• Required: One year of experience in a behavioral healthcare setting.
• Preferred: Previous experience as Precertification Specialist
• May substitute education for experience