Pre-Certification Specialist - Patient Contact Center

Description

JOB 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.

GENERAL REQUIREMENTS
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.

WORKING CONDITIONS
General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.

May be exposed to high noise levels and bright lights.

May be exposed to limited hazardous substances or body fluids, or infectious organisms.

May be required to change from one task to another of different nature without loss of efficiency or composure.

Periods of high stress and fluctuating workloads may occur.

May be scheduled as needed including overtime

Qualifications

EDUCATION REQUIREMENTS
High School Diploma or GED (Required)

EXPERIENCE REQUIREMENTS
2 years experience in a health-related environment (hospital or Physician's office) (Required)

CERTIFICATIONS AND LICENSURES
Required Certifications/Licensures: Certified Healthcare Access Associate (CHAA) within 15 months of hire; previous Certified Patient Account Representative (CPAR) certification acceptable

GENERAL SKILLS
Organizational Skills

Communication Skills

Interpersonal Skills

Customer Relations

Mathematical

Analytical

Grammar / Spelling

Read / Comprehend Written Instructions

Follow Verbal Instructions

Basic Computer Skills

Microsoft Office Suite

General Clerical Skills

Spanish or 2nd Language Preferred

PHYSICAL REQUIREMENTS
Have near normal vision - Clarity of vision (both near and far), ability to distinguish colors

Have good - manual dexterity

Have good eye-hand-foot coordination

Ability to perform - repetitive tasks/motion

PHYSICAL DEMANDS
Standing - Occasionally within shift (1-33%)

Walking - Occasionally within shift (1-33%)

Sitting - Continuously within shift (67-100%)

Bending/Stooping - Occasionally within shift (1-33%)

Pushing/Pulling - Occasionally within shift (1-33%)

Reaching above shoulder - Occasionally within shift (1-33%)

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