Job Details

In an environment of continuous quality improvement, the Precertification Assistant is responsible for assisting with the review of scheduled tests and surgeries, to verifying insurance information and coverage, determine authorizations, medical necessity is obtained, or medical coverage, for proper payment of testing. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.

Job Functions:

1. Acquires skills and maintains knowledge of system applications/websites used in precertification.
2. Determines if test/procedure requires authorization.
3. Reviews order for completeness.
4. Obtains appropriate authorization, checks medical necessity for Medicare patients, reviews Commercial Insurance medical policies to ensure proper payment from Insurance is received.
5. Contacts the provider's office via telephone or task to place a patient's testing on hold if authorization isn't obtained.
6. Notifies the providers office if a Peer to Peer option is available.
7. Tracks authorization information in all tabs of the authorization module.
8. Assumes all other duties and responsibilities as necessary.

Minimum Education/Experience Required:

• Minimum of 2 years' experience in hospital, medical office or clinic setting in registration dealing with insurance issues and/or scheduling experience preferred.
• Previous education in medical terminology, anatomy and physiology, or graduate/certification from medical office program preferred.
• If no previous education, anatomy and physiology will be required within 6 months of employment.

Special Knowledge, Skills, Training:

• Must have or be able to acquire and retain good knowledge of commercial, federal and state payor requirements.
• Needs good telephone voice and skill in handling business transactions, including irate patients.
• Ability to work with computerized system, also basic clerical and interpersonal skills and typing at 40 wpm.
• Ability to read, write and do math as generally demonstrated by a high school diploma or GED.

Compensation Details: Education, experience, and tenure may be considered along with internal equity when job offers are extended.

Benefits: Memorial Health System is proud to offer an affordable, comprehensive benefit package to all full time and flex time employees. To learn more about the many benefits we offer, please visit our website at www.mhsystem.org/benefits.

Bonus Eligibility: Available to qualifying full or flex time employees. Eligibility will be determined upon offer.

Memorial Health System is an equal opportunity provider and employer.

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

* Memorial Health System is a federal drug-free workplace. This policy prohibits marijuana use by employees.