Pre-Cert-Insurance Authorization Specialist

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process.

Department: Central Scheduling
Shift/schedule: Full Time (40 hrs/wk)

GENERAL SUMMARY

Works under the supervision of the Outpatient Prior Authorization supervisor and Lead. The Pre-Cert/Insurance Authorization Specialist primary job functions are to perform professional orderly, efficient insurance verification and pre-cert. The Pre-Cert/Insurance Authorization Specialist responsibilities are to verify insurance coverage/eligibility, obtain pre-certification/prior authorization, and benefit information through online systems and calling the insurance companies. Is responsible for safeguarding the public relations and confidentiality of the hospital and its records by consistent professional conduct. Performs other duties as assigned.

QUALIFICATIONS

Education:

• High School Diploma or successful completion of an equivalent High School Exam Required

Licensure:

• None

Experience:

• Six to twelve months of related work or hospital billing experience required
• Experience with computer preferred
• Insurance knowledge preferred
• Medical terminology preferred
• Scheduling knowledge preferred
• Knowledge of CPT/ICD 10 codes preferred

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS

The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

1. Collects accurate financial, demographic and clinical data involving interaction with patients, physicians, insurance companies and outside agencies to meet the registration/precert standard in all systems used by Registration/Central Scheduling.
2. Verifies coverage and eligibility, obtains Pre-certifications/Prior Authorizations on procedures that require outpt/surgery (Example: MRI, CAT Scan, Cardiac Testing).
3. Collects and maintains various department records, logs and statistical date timely and accurately as identified by the Central Scheduling Supervisor. Documents all correspondence telephone calls and account activity.
4. Assists in training and education of employees.
5. Obtain clinical notes for outpatient testing and outpatient surgery for insurance companies requirements
6. Reviews and works reports/work list for financial reimbursement
7. Reviews the Surgery Schedule for authorization and follows up with the physician office if it is not notated in the system with the required time
8. Performs other duties as assigned

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position in accordance with applicable law. A full job description is available upon request.

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Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.

Equal Opportunity Employer
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