Precertification Specialist
Job ID: 193490
Category: Customer Service/Patient Access
Work Type: FT
Location: Cherry Hill, NJ, United States
Work Schedule: Variable
Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Department: Penn Cardiology Cherry Hill NJ
Location: Penn Medicine Cherry Hill – 1865 Route 70 E
Entity: Clinical Care Associates
This position is Remote
Summary and Responsibilities:
- This position is responsible for obtaining referrals and authorizations for all applicable visits, testing, or procedures performed in an outpatient setting. Verifies eligibility and insurances via various tools and resources. Serves as the in-house expert for referral and authorization requirements - proactively advises patients and staff on insurance/managed care issues.
- This position is responsible for maintaining up to date knowledge of insurance requirements pertinent to patient services and billing procedures for Cardiology. Utilize Patient Workqueues in EPIC to identify testing procedures that require a referral or an authorization. Maintain registrations on insurance websites to allow for referral searches, and obtaining authorizations per insurance guidelines. Communicates with scheduling staff any appointments that need to be cancelled due to lack of authorization or authorization denial. Updates information in EPIC including, but not limited to: demographic and insurance, referral, and pre-auth information according to UPHS protocol. Develops a strong relationship with physicians and staff to ensure appropriate actions are taken in the event that a peer to peer is required to finalize an authorization. Appropriately documents all pertinent information on patient’s account. Creates referral/authorization shell. Maintains a positive patient experience at all times. Keeps manager aware of potential issues / problems as they arise.
Skills:
- Maintains up to date knowledge of insurance requirements pertinent to patient services and billing procedures.
- Updates information in EMR including but not limited to: demographics, insurance, referral, pre-authorizations according to UPHS protocol.
- Responsible for facilitating maximum revenue for the practice by managing strategies to collect monies from third party payers by ensuring referrals or authorizations have been obtained. Works to obtain any missing data or information so that the billing processes may proceed seamlessly
- Comprehends insurance and registration information as it relates to the various plans and benefits. Understands the need for referrals and pre-certs according to insurance requirements and coding.
- Communicates front end issues which may impact revenue process to manager
- Receives and responds to all correspondence, telephone calls, and other inquiries from designated carriers and patients.
- Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
- Other duties as assigned to support the unit, department, entity, and health system organization
Credentials:
Education or Equivalent Experience:
- High School Diploma/GED and 2+ years relevant experience (required)
- Bachelor's Degree - experience with pre-certs, referrals and prior auths (preferred)
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
