Job Details

Job Description

The Precertification Specialist is responsible for obtaining prior authorizations/pre-certifications, as required by third party payers, for procedures, testing and surgeries performed in the department or elsewhere. The position regularly interacts and collaborates with clinicians, technicians, other department staff and payer representatives to gather and submit necessary information, and then communicates with patients regarding their benefits and expected out-of-pocket costs.

• Obtains precertification/prior authorizations for in clinic procedures, testing, surgeries, injections, etc., as required by insurance prior to scheduled date for both facility and physician
  
• Coordinates with physician to ensure that patient's condition meets insurance eligibility criteria
  
• Updates appropriate work queues within Epic, including notes with updates on calls made, departments/people spoke with, prior auth numbers and authorization periods
  
• Interacts with the Financial Clearance Center Team to coordinate information needed to communicate benefits and patient responsibility for the facility billing portion
  
• Runs report on Experian to obtain the physician billing estimate and interacts with the Physician CBO to coordinate information needed to communicate benefits and patient responsibility for the physician billing portion
  
• Communicates regularly with patient to update on prior authorization and to provide patient responsibility estimate for both facility and physician billing sides.
  
• Interacts with OR and/or ASC staff to obtain scheduling information and to coordinate communication to the patient
  
• Schedules procedure with vendor rep, as needed