Precert Specialist CRHPP OSGA

Pre-Cert Specialist (FT) If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Location: Douglas, GA, US Position Summary Responsible for submitting and obtaining any required authorization/notification for tests performed to ensure proper reimbursement of claims. Responsible for scheduling patients for tests. Qualifications Reads and understands the English language. Ability to think critically and analytically with little or no supervision. Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes. Ability to process information and prioritize. Possesses exceptional verbal and written communication skills. Works independently, self‑reliant and self‑directed. Ability to learn, adapt, and change as required by the job functions. Maintains absolute confidentiality of material and information accessed and reviewed. Can move freely, reach, bend, and complete light lifting; uses good body mechanics and follows OSHA guidelines. Maintains attendance to meet standard job practices. High School Graduate or G.E.D. required. Minimum of five years experience in medical or financial field required; Certified or Registered Medical Assistant preferred. Basic understanding of Medicaid, Medicare and Commercial Insurance guidelines. Analytical and organizational skills above average. Attention to detail, communication, and documentation skills must be excellent. Prior public relations experience required. Operations of computer systems and business machinery also required. Excellent telephone communication skills; calm in difficult situations. Professional public speaking and interpretation of patient clinical information, charges, and explanations. Professional and neat appearance with excellent interpersonal communication skills. Benefits of a sedentary job: exert up to 10 lb. of force occasionally and/or a minute amount frequently >75%. Must understand and follow patient access guidelines, improve productivity, and perform work independently. Other Qualifications Exposure to hazards (body fluid exposure level). Age of Patient Populations Served: Adolescents 13‑18 years, Adults 19‑70 years, Geriatrics 70+ years. Job Specific Duties and Performance Standards Initiate contact with insurance companies, including internet use to obtain correct patient benefit information, deductible, co‑insurance amounts, and certification requirements. Contact insurance companies or authorized representatives to provide clinical information needed for authorization of medical services. Obtain needed clinical information from physician offices to facilitate authorization requirements and maintain open communication. Update schedule and contact patients and physician offices with necessary changes due to authorization requirements. Ensure all physician orders meet current standards and policies; obtain clarification of orders from physician offices. Cross‑train in Patient Access registration and accurately update patient demographic and insurance information when possible. Determine primary insurance liability in coordination of benefits cases (spouse, dependent child). Initiate communication to coworkers when insurance benefits are limited or lacking. Maintain acceptable accuracy rate based on Patient Access guidelines; obtain education and review accuracy as needed. Cross‑train in Scheduling to assist coworkers during absences and workload needs. Review prior accounts and make recommendations for their resolution as defined in hospital policies. Refer potential Medicaid patients to the Medicaid Benefit Specialist for screening. Notify physician offices of potential delays or changes due to certification requirements. Document all contact with patients, families, employers, and third‑party payers in the appropriate HIS system. Stay informed of any policy or regulation changes that could affect collection of receivables; update personal manual with current policy revisions. Answer telephone professionally and courteously; respond to inquiries timely. Document all patient complaints through the appropriate system. Understands the significance of the organization's Performance Improvement Programs and actively participates. Comply with all departmental policies of Patient Access. Report any problems to immediate supervisor daily as needed. Perform any and all other functions as required and directed by Supervisor, in a willing and positive manner. Coordinate scheduled absences with coworkers to provide adequate coverage. Maintain an accuracy rate of 95% for pre‑certifications/authorizations. Produce workable ideas and techniques, willingness to attempt new approaches and perform duties independently. Solve day‑to‑day problems within scope of practice and make timely decisions. Offer workable ideas, concepts, and techniques to improve productivity. Willing to attempt new job duties, tasks, etc. Maintain regulatory requirements, including all state, federal, and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility. Perform any other tasks as requested by Supervisor or Management in a willing and positive manner. #J-18808-Ljbffr