Pre-Certification Representative II - Medical Group Neurology

Pre-Certification Rep II

Hourly Pay Range: $20.69 - $30.00 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Summary:

Under the management of the Practice Manager for General Neurology/Headache, the Pre-Certification Representative II is responsible to initiate and manage referrals / pre-authorization / pre-certification based on clinical orders for an assigned patient population. In addition, the Pre-Certification Representative II is responsible to determine insurance eligibility and, as appropriate benefits and medical necessity requirements based on patient specific insurance. The Pre-Certification Representative II provides these services to ensure that our customers are provided a high-quality experience which includes understanding of patient responsibility and ease of access to clinical services. This is achieved through coordination with and education of the patient. The Pre-Certification Representative II helps to ensure that patient satisfaction and loyalty are achieved while hospital and Medical Group revenue is optimized.

What You Will Do:

• Submits referral and / or pre-certification requests for physician visits, diagnostic testing, procedures, Botox injections.
• Communicates and coordinates with office or physician if payer specific additional clinical information of physician peer to peer is necessary to successfully process the referral or pre-certification.
• Communicates negative payer determinations (denied authorizations) to ordering physician and Practice Manager to facilitate decision making in clinical next steps.
• Communicates third party payer decision on authorization / pre-certification to patient. This includes communication and education of patient regarding patient specific insurance carrier requirements and possible out of pocket patient responsibility.
• Documents outcomes and statuses related to all referral and pre-certification requests in Epic. This includes approvals, denials, status, outcomes, etc.
• Consistently follows prescribed workflows, standards and protocols for managing and obtaining referrals, authorizations and priorities.

What You Will Need:

• Education: High School Diploma
• Experience: 1 year of related insurance experience required. Registration and billing experience preferred. Experience with referral and pre-certification initiation, processing and coordination strongly preferred.

Benefits (For full time or part time positions):

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) all recognized as Magnet hospitals for nursing excellence.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belongingeach of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.