Precertification Specialist

Position Summary:Responsible for obtaining pre-certifications and pre-authorizations for hospital service lines per assigned caseload by successfully completing the required authorization process in addition to effectively communicating details to appropriate departments.Position Responsibilities:Clinical / Technical Skills (40% of performance review)Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.Request, track and obtain pre-authorization from insurance carriers within time allotted for assigned workload and follow up on regularly pending cases.Ensure tracking programs and patient records are kept up to date through the pre-certification process.Demonstrate and apply knowledge of medical terminology, high proficiency of general inpatient hospital understanding including HIPAA regulations.Clearly document all communication and contacts with providers and personnel in standardized documentation requirements.Communicate any insurance changes or trends among team.Prioritize authorization requests according to urgency.Answer insurance telephone inquiries pertaining to patient accounts.Perform other duties as required.Safety (15% of performance review)Strives to create a safe, healing environment for patients and family membersFollows all safety rules while on the job.Reports “near misses”, as well as errors and accidents promptly.Corrects minor safety hazards.Communicates with peers and management regarding any hazards identified in the workplace.Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.Participates in quality projects, as assigned, and supports quality initiatives.Supports and maintains a culture of safety and quality.Teamwork (15% of performance review)Works well with others in a spirit of teamwork and cooperation.Responds willingly to colleagues and serves as an active part of the hospital team.Builds collaborative relationships with patients, families, staff, and physicians.The ability to retrieve, communicate, and present data and information both verbally and in writing as requiredDemonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.Demonstrates adequate skills in all forms of communication.Adheres to the Standards of BehaviorIntegrity (15% of performance review)Strives to always do the right thing for the patient, coworkers, and the hospitalAdheres to established standards, policies, procedures, protocols, and laws.Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.Completes required trainings within defined time periods, as established by job description, policies, or hospital leadershipExemplifies professionalism through good attendance and positive attitude, at all times.Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.Ensures proper documentation in all position activities, following federal and state guidelines.Compassion (15% of performance review)Demonstrates accountability for ensuring the highest quality patient care for patients.Willingness to be accepting of those in need, and to extend a helping handDesire to go above and beyond for othersUnderstanding and accepting of cultural diversity and differencesEducationRequired: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.Preferred: Associates or Bachelors degree.Maintains education and development appropriate for position.May substitute experience for educationExperienceRequired: One year of experience in a behavioral healthcare setting.Preferred: Previous experience as Precertification SpecialistMay substitute education for experience #J-18808-Ljbffr