PRE-CERTIFICATION SPECIALIST

Job Description

• POSITION SUMMARY
  
  • The Therapy Pre-Certification Specialist is responsible for all aspects of the prior authorization process and helps support the delivery of therapy services to patients in a timely manner. This includes but is not limited to developing and refining processes for collecting all necessary documentation, contacting the ordering provider and/or provider offices, updating patient and claim information, and completion of pre-determination processes to obtain precertification and/or benefit eligibility verification for patients at Trinity Health. This position works collaboratively as part of the revenue cycle program to ensure therapy and clinical services are authorized based on insurance payer guidelines to minimize the reimbursement risks associated with providing care to patients. This position is responsible to work with business office representatives and coding staff to develop and improve co-pay collection, and work on appeals and denials.
    
• MINIMUM QUALIFICATIONS AND REQUIREMENTS
  
  • Licenses and Certifications Required
    
    • CPR preferred, but not required.
      
  • Educational Requirements
    
    • High School diploma or equivalent preferred.
      
    • Prefer Associates degree in business or healthcare related field.
      
  • Experience Requirements
    
    • Minimum of three years' medical insurance pre-certification and verification experience.
      
    • Therapy pre-certification or healthcare office experience strongly preferred.
      
    • Working knowledge of CPT/ICD coding and medical terminology.
      
    • Experience with third party payer billing regulations, reimbursement requirements, precertification, and/or utilization management is preferred.
      
  • Special Skills or Training Requirements
    
    • Demonstrated advanced communication and interpersonal skills with all levels of internal and external customers.
      
    • Self-directed, attention to detail, PC experience, proficient in Microsoft Office Suite applications including Outlook, Word and Excel, excellent written and oral communication skills.
      
    • Ability to handle high workload volume.
      
    • Must be flexible and demonstrate ability to be adaptable.